| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
542 |
482 |
$16K |
| V2020 |
Frames, purchases |
589 |
537 |
$6K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
126 |
124 |
$4K |
| 92015 |
Determination of refractive state |
784 |
699 |
$2K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
93 |
41 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
117 |
60 |
$288.25 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
25 |
14 |
$102.06 |