| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
234 |
220 |
$21K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
135 |
124 |
$12K |
| V2020 |
Frames, purchases |
352 |
315 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
81 |
72 |
$62.18 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
128 |
111 |
$39.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
13 |
13 |
$0.00 |