| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,270 |
1,263 |
$46K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
715 |
707 |
$27K |
| V2020 |
Frames, purchases |
1,517 |
1,494 |
$25K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
878 |
867 |
$17K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
816 |
798 |
$7K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
219 |
219 |
$5K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$452.40 |
| 92015 |
Determination of refractive state |
2,051 |
2,036 |
$0.00 |