| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
395 |
386 |
$37K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
487 |
476 |
$35K |
| V2020 |
Frames, purchases |
1,015 |
988 |
$34K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
740 |
698 |
$32K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
755 |
706 |
$20K |
| 92015 |
Determination of refractive state |
1,194 |
1,164 |
$6K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
21 |
20 |
$579.86 |