| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
497 |
493 |
$23K |
| V2020 |
Frames, purchases |
478 |
468 |
$12K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
13 |
13 |
$918.45 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
28 |
14 |
$361.44 |
| V2756 |
Eye glass case |
337 |
332 |
$355.32 |
| 92015 |
Determination of refractive state |
1,044 |
1,034 |
$285.95 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
42 |
41 |
$156.96 |