| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
453 |
449 |
$14K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
415 |
407 |
$12K |
| V2020 |
Frames, purchases |
691 |
664 |
$9K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
536 |
522 |
$9K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
371 |
356 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
17 |
17 |
$432.96 |
| 92015 |
Determination of refractive state |
926 |
914 |
$0.00 |