| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
481 |
413 |
$20K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
458 |
375 |
$18K |
| V2020 |
Frames, purchases |
922 |
760 |
$15K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
663 |
569 |
$12K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
531 |
438 |
$5K |
| 92015 |
Determination of refractive state |
1,065 |
885 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
139 |
97 |
$1K |
| V2744 |
Tint, photochromatic, per lens |
26 |
12 |
$110.00 |