| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
302 |
296 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
70 |
70 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
88 |
88 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
222 |
220 |
$1K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
12 |
12 |
$583.57 |
| 92015 |
Determination of refractive state |
296 |
289 |
$371.14 |