| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
561 |
527 |
$48K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
459 |
427 |
$47K |
| V2020 |
Frames, purchases |
1,050 |
947 |
$24K |
| 92015 |
Determination of refractive state |
1,756 |
1,590 |
$21K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
680 |
468 |
$17K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
159 |
147 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
54 |
30 |
$1K |