| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
282 |
234 |
$24K |
| V2020 |
Frames, purchases |
454 |
371 |
$17K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
160 |
115 |
$16K |
| 92015 |
Determination of refractive state |
562 |
450 |
$8K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
252 |
121 |
$7K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
89 |
41 |
$2K |
| V2755 |
U-v lens, per lens |
269 |
135 |
$2K |