| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,173 |
2,029 |
$207K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,728 |
1,629 |
$148K |
| V2020 |
Frames, purchases |
2,874 |
2,645 |
$105K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,349 |
1,216 |
$62K |
| 92015 |
Determination of refractive state |
4,193 |
3,944 |
$56K |
| V2755 |
U-v lens, per lens |
951 |
848 |
$21K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
695 |
647 |
$20K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
14 |
14 |
$1K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
12 |
12 |
$278.33 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
16 |
12 |
$223.06 |