| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
603 |
595 |
$52K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
611 |
581 |
$31K |
| 92015 |
Determination of refractive state |
757 |
721 |
$10K |
| V2020 |
Frames, purchases |
402 |
381 |
$10K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
75 |
74 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
230 |
223 |
$540.64 |
| V2756 |
Eye glass case |
166 |
160 |
$157.68 |