| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
334 |
334 |
$11K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
542 |
269 |
$9K |
| V2020 |
Frames, purchases |
626 |
621 |
$6K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
48 |
24 |
$451.88 |
| 92015 |
Determination of refractive state |
408 |
408 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
204 |
101 |
$0.00 |