| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
53 |
52 |
$4K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
27 |
27 |
$2K |
| V2020 |
Frames, purchases |
98 |
97 |
$2K |
| 92015 |
Determination of refractive state |
119 |
118 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
39 |
26 |
$859.32 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
17 |
12 |
$488.40 |