| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
402 |
398 |
$17K |
| V2020 |
Frames, purchases |
998 |
995 |
$15K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
173 |
172 |
$7K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
252 |
252 |
$4K |
| 92283 |
|
203 |
203 |
$4K |
| 92015 |
Determination of refractive state |
1,038 |
1,035 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
89 |
89 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
124 |
124 |
$2K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
27 |
27 |
$1K |
| V2755 |
U-v lens, per lens |
173 |
173 |
$988.00 |