| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
315 |
315 |
$5K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
110 |
110 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
68 |
68 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
104 |
104 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
54 |
54 |
$387.50 |
| 92015 |
Determination of refractive state |
308 |
306 |
$0.00 |