| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
115 |
111 |
$6K |
| V2020 |
Frames, purchases |
123 |
115 |
$2K |
| 92015 |
Determination of refractive state |
86 |
84 |
$443.33 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
32 |
31 |
$391.04 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
31 |
17 |
$362.88 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
32 |
31 |
$118.68 |