| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
726 |
725 |
$31K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,282 |
630 |
$26K |
| V2020 |
Frames, purchases |
1,235 |
1,213 |
$15K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
322 |
322 |
$14K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
98 |
50 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,534 |
1,253 |
$440.00 |