| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
615 |
545 |
$48K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
387 |
360 |
$40K |
| V2020 |
Frames, purchases |
1,037 |
917 |
$32K |
| 92015 |
Determination of refractive state |
1,367 |
1,222 |
$16K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
247 |
168 |
$7K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
168 |
161 |
$4K |
| V2755 |
U-v lens, per lens |
244 |
216 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
19 |
14 |
$324.14 |
| V2760 |
Scratch resistant coating, per lens |
57 |
46 |
$184.92 |