| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
156 |
121 |
$10K |
| V2020 |
Frames, purchases |
199 |
149 |
$3K |
| 92015 |
Determination of refractive state |
320 |
274 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
78 |
73 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
34 |
33 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
24 |
13 |
$12.76 |
| V2756 |
Eye glass case |
12 |
12 |
$7.56 |
| 2033F |
|
13 |
13 |
$0.00 |