| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
129 |
129 |
$6K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
73 |
73 |
$3K |
| V2020 |
Frames, purchases |
119 |
117 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
55 |
53 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
62 |
60 |
$1K |
| 92015 |
Determination of refractive state |
65 |
65 |
$0.00 |