| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
562 |
541 |
$51K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
441 |
437 |
$30K |
| V2020 |
Frames, purchases |
817 |
742 |
$19K |
| 92370 |
|
440 |
412 |
$6K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
248 |
223 |
$5K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
183 |
166 |
$4K |
| V2756 |
Eye glass case |
701 |
642 |
$672.81 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
25 |
25 |
$348.80 |