| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
206 |
205 |
$534.48 |
| V2020 |
Frames, purchases |
610 |
432 |
$0.00 |
| 92015 |
Determination of refractive state |
459 |
431 |
$0.00 |
| V2025 |
Deluxe frame |
404 |
277 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
415 |
306 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
393 |
287 |
$0.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
27 |
27 |
$0.00 |