| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
733 |
717 |
$23K |
| V2020 |
Frames, purchases |
893 |
873 |
$15K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
253 |
250 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
60 |
60 |
$639.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
20 |
20 |
$605.00 |
| 92002 |
|
12 |
12 |
$365.00 |
| 92015 |
Determination of refractive state |
596 |
588 |
$184.30 |