| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
405 |
394 |
$24K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
254 |
247 |
$22K |
| V2020 |
Frames, purchases |
547 |
533 |
$13K |
| 92015 |
Determination of refractive state |
1,207 |
1,127 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
45 |
42 |
$887.12 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
28 |
26 |
$547.88 |
| V2756 |
Eye glass case |
265 |
259 |
$273.24 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
54 |
54 |
$56.00 |