| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
97 |
97 |
$10K |
| 92015 |
Determination of refractive state |
205 |
205 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
25 |
25 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
58 |
29 |
$1K |
| V2020 |
Frames, purchases |
84 |
84 |
$923.50 |
| 92250 |
|
13 |
13 |
$838.50 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
28 |
14 |
$534.04 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
110 |
55 |
$0.00 |