| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
465 |
356 |
$17K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
429 |
334 |
$17K |
| V2020 |
Frames, purchases |
1,013 |
774 |
$16K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
809 |
626 |
$15K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
852 |
660 |
$11K |
| 92015 |
Determination of refractive state |
1,049 |
818 |
$4K |