| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
568 |
555 |
$23K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
251 |
106 |
$7K |
| V2020 |
Frames, purchases |
151 |
127 |
$6K |
| V2750 |
Anti-reflective coating, per lens |
57 |
26 |
$1K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
12 |
12 |
$492.70 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
128 |
51 |
$165.00 |
| 92015 |
Determination of refractive state |
31 |
31 |
$60.00 |