| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
362 |
355 |
$24K |
| V2020 |
Frames, purchases |
722 |
623 |
$20K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
185 |
145 |
$13K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
189 |
151 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
101 |
99 |
$506.37 |
| V2755 |
U-v lens, per lens |
92 |
54 |
$456.60 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
13 |
13 |
$210.00 |
| 92015 |
Determination of refractive state |
1,080 |
954 |
$0.00 |