| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,693 |
1,663 |
$107K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
568 |
554 |
$51K |
| V2020 |
Frames, purchases |
1,731 |
1,634 |
$43K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
822 |
780 |
$17K |
| V2756 |
Eye glass case |
1,606 |
1,542 |
$2K |
| 92015 |
Determination of refractive state |
2,614 |
2,558 |
$15.05 |