| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
703 |
693 |
$58K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
923 |
906 |
$54K |
| V2020 |
Frames, purchases |
751 |
716 |
$18K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
483 |
468 |
$13K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
444 |
430 |
$3K |
| V2756 |
Eye glass case |
404 |
384 |
$406.08 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
13 |
12 |
$308.48 |
| 92015 |
Determination of refractive state |
95 |
93 |
$225.75 |