| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
449 |
388 |
$19K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
366 |
292 |
$14K |
| V2020 |
Frames, purchases |
851 |
705 |
$14K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
659 |
552 |
$12K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
488 |
378 |
$4K |
| 92015 |
Determination of refractive state |
994 |
839 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
106 |
90 |
$925.26 |