| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
588 |
456 |
$27K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
189 |
164 |
$17K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
220 |
183 |
$12K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
117 |
78 |
$9K |
| 92015 |
Determination of refractive state |
612 |
468 |
$9K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
22 |
12 |
$854.70 |