| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,380 |
1,011 |
$35K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
372 |
331 |
$26K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
330 |
254 |
$25K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
865 |
692 |
$24K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,238 |
923 |
$20K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
27 |
26 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
18 |
13 |
$473.68 |
| 92015 |
Determination of refractive state |
85 |
84 |
$127.44 |