| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
83 |
83 |
$3K |
| V2020 |
Frames, purchases |
151 |
149 |
$1K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
31 |
31 |
$1K |
| 92015 |
Determination of refractive state |
154 |
153 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
40 |
39 |
$670.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
148 |
145 |
$570.00 |