| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
154 |
151 |
$6K |
| 92250 |
|
119 |
119 |
$4K |
| V2020 |
Frames, purchases |
66 |
66 |
$940.20 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
51 |
26 |
$830.60 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
15 |
15 |
$760.00 |
| 92285 |
|
62 |
62 |
$601.19 |
| 92060 |
|
13 |
13 |
$458.38 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
50 |
25 |
$0.00 |