| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,035 |
1,030 |
$36K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,167 |
1,073 |
$34K |
| V2020 |
Frames, purchases |
1,647 |
1,624 |
$21K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
390 |
390 |
$17K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
77 |
37 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
86 |
43 |
$410.80 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
100 |
50 |
$0.00 |
| V2755 |
U-v lens, per lens |
68 |
34 |
$0.00 |