| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
405 |
368 |
$17K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
391 |
346 |
$16K |
| V2020 |
Frames, purchases |
801 |
711 |
$14K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
558 |
518 |
$8K |
| 92015 |
Determination of refractive state |
921 |
832 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
298 |
258 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
97 |
84 |
$517.12 |