| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
88 |
86 |
$1K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
53 |
52 |
$768.40 |
| 92015 |
Determination of refractive state |
24 |
24 |
$105.60 |
| V2020 |
Frames, purchases |
106 |
105 |
$80.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
153 |
77 |
$63.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
26 |
13 |
$0.00 |