| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
479 |
475 |
$5K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
108 |
107 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
38 |
38 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
28 |
14 |
$575.12 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
12 |
12 |
$480.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
968 |
481 |
$0.00 |