| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
335 |
335 |
$14K |
| V2020 |
Frames, purchases |
453 |
449 |
$7K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
103 |
103 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
75 |
74 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
128 |
126 |
$2K |
| 92015 |
Determination of refractive state |
632 |
624 |
$104.15 |