| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
316 |
315 |
$3K |
| V2020 |
Frames, purchases |
558 |
554 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
296 |
147 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
213 |
106 |
$1K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
26 |
13 |
$400.12 |
| 92002 |
|
16 |
15 |
$120.00 |