| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,091 |
1,076 |
$95K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
496 |
488 |
$32K |
| V2020 |
Frames, purchases |
1,308 |
1,186 |
$31K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
160 |
149 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
88 |
86 |
$2K |
| 92370 |
|
52 |
46 |
$690.00 |
| V2756 |
Eye glass case |
289 |
280 |
$299.16 |
| 92015 |
Determination of refractive state |
558 |
553 |
$0.00 |