| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
585 |
562 |
$48K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
507 |
477 |
$31K |
| V2020 |
Frames, purchases |
860 |
795 |
$22K |
| 92002 |
|
117 |
115 |
$6K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
112 |
79 |
$2K |
| 92015 |
Determination of refractive state |
599 |
526 |
$1K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
13 |
13 |
$566.90 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
21 |
20 |
$394.80 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
16 |
14 |
$354.88 |
| V2756 |
Eye glass case |
90 |
84 |
$86.40 |