| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
382 |
381 |
$27K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
259 |
254 |
$24K |
| V2020 |
Frames, purchases |
640 |
605 |
$17K |
| 92370 |
|
332 |
321 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
162 |
153 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
96 |
92 |
$2K |
| 92250 |
|
13 |
13 |
$702.57 |
| V2756 |
Eye glass case |
597 |
571 |
$591.84 |
| V2025 |
Deluxe frame |
25 |
24 |
$497.26 |