| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
98 |
86 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
61 |
52 |
$920.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
64 |
57 |
$895.68 |
| V2020 |
Frames, purchases |
81 |
70 |
$690.96 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
20 |
17 |
$365.00 |
| 92015 |
Determination of refractive state |
54 |
46 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
15 |
14 |
$0.00 |