| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,406 |
1,370 |
$137K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,618 |
1,561 |
$133K |
| V2020 |
Frames, purchases |
2,855 |
2,682 |
$110K |
| 92015 |
Determination of refractive state |
3,904 |
3,793 |
$53K |
| V2755 |
U-v lens, per lens |
2,333 |
1,674 |
$32K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
934 |
626 |
$27K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
533 |
419 |
$24K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
80 |
80 |
$8K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
85 |
79 |
$3K |