| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
196 |
195 |
$8K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
216 |
135 |
$8K |
| V2020 |
Frames, purchases |
205 |
201 |
$6K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
80 |
80 |
$3K |
| 92015 |
Determination of refractive state |
54 |
54 |
$511.10 |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
13 |
13 |
$452.11 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
28 |
12 |
$60.00 |