| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
368 |
364 |
$31K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
389 |
372 |
$24K |
| V2020 |
Frames, purchases |
622 |
576 |
$15K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
314 |
183 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
89 |
65 |
$1K |
| 92015 |
Determination of refractive state |
876 |
851 |
$30.10 |