| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
143 |
103 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
114 |
88 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
120 |
110 |
$3K |
| 92015 |
Determination of refractive state |
504 |
377 |
$2K |
| V2020 |
Frames, purchases |
102 |
82 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
27 |
12 |
$245.74 |