| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
886 |
866 |
$53K |
| V2020 |
Frames, purchases |
899 |
858 |
$21K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
159 |
149 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
74 |
69 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
22 |
17 |
$2K |
| 92370 |
|
99 |
99 |
$1K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
14 |
14 |
$424.81 |
| 92250 |
|
12 |
12 |
$346.61 |
| V2756 |
Eye glass case |
251 |
243 |
$254.88 |
| 92015 |
Determination of refractive state |
199 |
185 |
$30.10 |