| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,658 |
1,598 |
$67K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,504 |
1,245 |
$55K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,005 |
902 |
$54K |
| V2020 |
Frames, purchases |
1,969 |
1,548 |
$37K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
105 |
104 |
$5K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
80 |
52 |
$3K |
| 92015 |
Determination of refractive state |
421 |
404 |
$2K |
| 92250 |
|
25 |
25 |
$1K |
| V2760 |
Scratch resistant coating, per lens |
82 |
40 |
$685.00 |