| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
959 |
922 |
$15K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
254 |
242 |
$9K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
121 |
108 |
$5K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
103 |
98 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
82 |
80 |
$806.00 |
| 92015 |
Determination of refractive state |
786 |
756 |
$187.47 |