| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
292 |
291 |
$13K |
| V2020 |
Frames, purchases |
368 |
335 |
$8K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
131 |
131 |
$6K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
188 |
187 |
$5K |
| 92015 |
Determination of refractive state |
606 |
573 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
180 |
177 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$652.95 |