| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,108 |
1,022 |
$57K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
754 |
655 |
$40K |
| V2025 |
Deluxe frame |
338 |
337 |
$15K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
401 |
400 |
$13K |
| V2020 |
Frames, purchases |
208 |
197 |
$10K |
| 92015 |
Determination of refractive state |
1,491 |
1,357 |
$8K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
26 |
26 |
$1K |
| 92250 |
|
27 |
26 |
$685.76 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
53 |
53 |
$292.39 |
| V2760 |
Scratch resistant coating, per lens |
43 |
43 |
$0.00 |