| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
853 |
804 |
$48K |
| V2020 |
Frames, purchases |
1,054 |
997 |
$25K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
82 |
80 |
$7K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
228 |
214 |
$5K |
| 92370 |
|
96 |
90 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
26 |
24 |
$627.72 |
| V2756 |
Eye glass case |
428 |
422 |
$454.68 |
| 92250 |
|
14 |
14 |
$297.34 |
| 92015 |
Determination of refractive state |
199 |
173 |
$15.05 |