| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
825 |
815 |
$31K |
| V2020 |
Frames, purchases |
1,111 |
1,094 |
$19K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
850 |
836 |
$19K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
203 |
203 |
$9K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
358 |
357 |
$4K |
| 92015 |
Determination of refractive state |
45 |
45 |
$8.93 |