| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,486 |
1,264 |
$110K |
| V2020 |
Frames, purchases |
1,441 |
1,231 |
$52K |
| 92015 |
Determination of refractive state |
3,800 |
3,214 |
$49K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,082 |
875 |
$48K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
132 |
113 |
$14K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
49 |
44 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
44 |
19 |
$1K |
| V2755 |
U-v lens, per lens |
36 |
30 |
$1K |
| 92002 |
|
16 |
16 |
$874.08 |