| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
473 |
469 |
$35K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
280 |
278 |
$24K |
| V2020 |
Frames, purchases |
488 |
462 |
$12K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
233 |
183 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
47 |
45 |
$1K |
| V2756 |
Eye glass case |
32 |
30 |
$31.32 |
| 92015 |
Determination of refractive state |
1,058 |
1,045 |
$0.00 |