| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
936 |
931 |
$62K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
455 |
451 |
$36K |
| V2020 |
Frames, purchases |
762 |
753 |
$22K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
563 |
558 |
$14K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
276 |
274 |
$321.44 |
| V2756 |
Eye glass case |
28 |
27 |
$27.00 |
| 92015 |
Determination of refractive state |
1,538 |
1,526 |
$0.00 |