| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
787 |
744 |
$42K |
| V2020 |
Frames, purchases |
987 |
949 |
$38K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
215 |
206 |
$11K |
| 92015 |
Determination of refractive state |
1,477 |
1,366 |
$7K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
58 |
56 |
$5K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
83 |
81 |
$3K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
73 |
72 |
$710.00 |