| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
413 |
412 |
$43K |
| V2020 |
Frames, purchases |
712 |
697 |
$25K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
196 |
193 |
$24K |
| 92015 |
Determination of refractive state |
779 |
771 |
$17K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
133 |
132 |
$5K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
113 |
113 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
505 |
484 |
$0.00 |