| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
498 |
357 |
$14K |
| V2020 |
Frames, purchases |
554 |
364 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
115 |
81 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
310 |
199 |
$2K |
| 92015 |
Determination of refractive state |
364 |
281 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
114 |
85 |
$466.19 |
| 2026F |
|
126 |
50 |
$0.00 |