| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
230 |
230 |
$3K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
30 |
30 |
$389.20 |
| 92015 |
Determination of refractive state |
94 |
94 |
$136.40 |
| V2020 |
Frames, purchases |
166 |
162 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
30 |
15 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
114 |
56 |
$0.00 |