| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,404 |
1,388 |
$119K |
| V2020 |
Frames, purchases |
2,343 |
2,214 |
$62K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,353 |
1,227 |
$56K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,545 |
1,412 |
$31K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,413 |
1,279 |
$16K |
| 92015 |
Determination of refractive state |
2,813 |
2,673 |
$11K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
302 |
288 |
$6K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
188 |
172 |
$2K |
| V2025 |
Deluxe frame |
13 |
12 |
$0.00 |