| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
50 |
50 |
$4K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
16 |
16 |
$1K |
| 92015 |
Determination of refractive state |
78 |
78 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
44 |
22 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
57 |
34 |
$997.50 |
| V2020 |
Frames, purchases |
68 |
67 |
$476.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
25 |
16 |
$375.00 |