| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
319 |
304 |
$20K |
| 92015 |
Determination of refractive state |
972 |
945 |
$14K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
120 |
115 |
$11K |
| V2020 |
Frames, purchases |
354 |
341 |
$8K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
133 |
132 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
137 |
132 |
$562.80 |
| V2756 |
Eye glass case |
208 |
205 |
$221.83 |