| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
594 |
582 |
$16K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
633 |
622 |
$8K |
| V2020 |
Frames, purchases |
739 |
724 |
$8K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
303 |
292 |
$7K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
335 |
327 |
$3K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
42 |
42 |
$455.00 |
| 92015 |
Determination of refractive state |
815 |
794 |
$0.00 |