| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
590 |
451 |
$30K |
| V2020 |
Frames, purchases |
412 |
405 |
$11K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
131 |
91 |
$9K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
114 |
111 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
38 |
30 |
$714.56 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
88 |
88 |
$104.72 |
| 92015 |
Determination of refractive state |
881 |
661 |
$0.00 |