| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
3,556 |
3,304 |
$189K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
803 |
772 |
$45K |
| V2020 |
Frames, purchases |
525 |
389 |
$10K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
294 |
141 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
72 |
49 |
$368.37 |
| V2755 |
U-v lens, per lens |
60 |
40 |
$365.98 |
| 92015 |
Determination of refractive state |
741 |
570 |
$202.20 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
28 |
12 |
$200.00 |