| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
124 |
124 |
$9K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
90 |
90 |
$3K |
| 92015 |
Determination of refractive state |
185 |
185 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
28 |
28 |
$2K |
| V2020 |
Frames, purchases |
114 |
114 |
$2K |
| V2755 |
U-v lens, per lens |
29 |
29 |
$96.58 |