| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
211 |
211 |
$13K |
| V2020 |
Frames, purchases |
251 |
251 |
$4K |
| 92002 |
|
58 |
58 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
33 |
33 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
103 |
103 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
26 |
26 |
$612.48 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
250 |
250 |
$576.32 |
| V2101 |
Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens |
27 |
27 |
$433.84 |
| 92015 |
Determination of refractive state |
216 |
216 |
$0.00 |