| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,037 |
1,035 |
$41K |
| V2020 |
Frames, purchases |
1,448 |
1,433 |
$21K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
622 |
618 |
$15K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
415 |
410 |
$5K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
297 |
294 |
$4K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
62 |
62 |
$2K |
| 92015 |
Determination of refractive state |
180 |
180 |
$0.00 |