| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
475 |
455 |
$12K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,274 |
1,205 |
$12K |
| V2020 |
Frames, purchases |
1,483 |
1,463 |
$10K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,198 |
828 |
$6K |
| 92250 |
|
161 |
157 |
$4K |
| 92015 |
Determination of refractive state |
317 |
302 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
158 |
106 |
$642.20 |
| 2033F |
|
14 |
13 |
$0.00 |