| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
881 |
871 |
$50K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
818 |
808 |
$43K |
| V2020 |
Frames, purchases |
1,528 |
1,496 |
$23K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
890 |
872 |
$22K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
709 |
684 |
$8K |
| 92015 |
Determination of refractive state |
1,386 |
1,383 |
$2K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
46 |
45 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
170 |
162 |
$1K |