| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,124 |
1,119 |
$78K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
536 |
529 |
$32K |
| V2020 |
Frames, purchases |
614 |
595 |
$15K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
200 |
193 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
176 |
174 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
87 |
84 |
$786.55 |