| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
199 |
179 |
$17K |
| V2020 |
Frames, purchases |
147 |
117 |
$5K |
| 92015 |
Determination of refractive state |
849 |
746 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
42 |
42 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
48 |
16 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
17 |
12 |
$306.18 |
| 2026F |
|
29 |
29 |
$0.00 |