| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,331 |
1,331 |
$37K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
330 |
330 |
$16K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
489 |
489 |
$9K |
| 92015 |
Determination of refractive state |
1,003 |
1,002 |
$7K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
24 |
24 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
261 |
261 |
$346.72 |