| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
55 |
55 |
$4K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
32 |
31 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
48 |
47 |
$2K |
| V2020 |
Frames, purchases |
99 |
95 |
$2K |
| 92015 |
Determination of refractive state |
112 |
108 |
$1K |
| V2755 |
U-v lens, per lens |
26 |
26 |
$78.46 |