| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
696 |
564 |
$29K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
188 |
125 |
$7K |
| V2020 |
Frames, purchases |
308 |
133 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
116 |
42 |
$1K |
| 92015 |
Determination of refractive state |
372 |
168 |
$926.50 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
92 |
24 |
$603.48 |
| V2780 |
Oversize lens, per lens |
97 |
21 |
$512.64 |