| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
558 |
558 |
$28K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
476 |
476 |
$22K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
139 |
139 |
$9K |
| V2020 |
Frames, purchases |
428 |
428 |
$8K |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
16 |
16 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
62 |
62 |
$2K |