| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
267 |
188 |
$9K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
214 |
157 |
$8K |
| V2020 |
Frames, purchases |
290 |
199 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
170 |
114 |
$3K |
| 92015 |
Determination of refractive state |
747 |
568 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
57 |
29 |
$610.10 |