| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
629 |
570 |
$34K |
| V2020 |
Frames, purchases |
831 |
695 |
$18K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
134 |
122 |
$11K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
414 |
345 |
$8K |
| 92015 |
Determination of refractive state |
151 |
141 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
562 |
481 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
18 |
15 |
$357.28 |
| V2756 |
Eye glass case |
243 |
227 |
$236.97 |