| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,184 |
1,992 |
$174K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
865 |
789 |
$89K |
| V2020 |
Frames, purchases |
1,789 |
1,670 |
$59K |
| 92015 |
Determination of refractive state |
3,804 |
3,468 |
$53K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
802 |
745 |
$40K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
14 |
13 |
$878.45 |
| V2755 |
U-v lens, per lens |
34 |
34 |
$786.98 |
| 1036F |
|
13 |
12 |
$0.00 |
| G9903 |
Patient screened for tobacco use and identified as a tobacco non-user |
13 |
12 |
$0.00 |