| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
688 |
602 |
$45K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
245 |
219 |
$20K |
| V2020 |
Frames, purchases |
916 |
797 |
$12K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
510 |
452 |
$9K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
28 |
26 |
$492.15 |