| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,400 |
1,387 |
$53K |
| V2020 |
Frames, purchases |
1,907 |
1,885 |
$22K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
890 |
444 |
$18K |
| V2199 |
Not otherwise classified, single vision lens |
1,122 |
560 |
$10K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
164 |
94 |
$1K |
| 92015 |
Determination of refractive state |
115 |
113 |
$228.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
844 |
422 |
$0.00 |
| V2755 |
U-v lens, per lens |
24 |
12 |
$0.00 |