| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
191 |
191 |
$8K |
| V2020 |
Frames, purchases |
269 |
267 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
161 |
160 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
63 |
63 |
$806.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
17 |
17 |
$687.36 |
| 92015 |
Determination of refractive state |
213 |
213 |
$0.00 |