| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
470 |
458 |
$57K |
| V2020 |
Frames, purchases |
693 |
659 |
$41K |
| 92015 |
Determination of refractive state |
934 |
912 |
$16K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
108 |
108 |
$11K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
184 |
169 |
$10K |
| V2755 |
U-v lens, per lens |
213 |
203 |
$6K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
12 |
12 |
$497.78 |