| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
166 |
157 |
$7K |
| V2020 |
Frames, purchases |
161 |
108 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
164 |
69 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
34 |
33 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
118 |
45 |
$413.00 |
| 92015 |
Determination of refractive state |
18 |
17 |
$0.00 |