| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
449 |
446 |
$26K |
| V2020 |
Frames, purchases |
519 |
515 |
$14K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
164 |
164 |
$14K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
163 |
161 |
$7K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
174 |
172 |
$4K |
| V2756 |
Eye glass case |
388 |
387 |
$406.08 |