| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
134 |
132 |
$6K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
110 |
109 |
$3K |
| V2020 |
Frames, purchases |
165 |
161 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
12 |
12 |
$514.56 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
53 |
52 |
$481.00 |
| 92015 |
Determination of refractive state |
189 |
186 |
$0.00 |
| V2744 |
Tint, photochromatic, per lens |
32 |
31 |
$0.00 |