| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
632 |
591 |
$28K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
520 |
488 |
$26K |
| V2020 |
Frames, purchases |
423 |
420 |
$16K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
58 |
56 |
$3K |
| 92015 |
Determination of refractive state |
145 |
142 |
$346.58 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
13 |
12 |
$40.00 |