| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
136 |
136 |
$6K |
| V2020 |
Frames, purchases |
322 |
322 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
121 |
121 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
103 |
103 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
97 |
97 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
38 |
38 |
$760.00 |
| 92015 |
Determination of refractive state |
202 |
202 |
$0.00 |