| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,344 |
1,335 |
$94K |
| 92015 |
Determination of refractive state |
2,037 |
2,018 |
$29K |
| V2020 |
Frames, purchases |
908 |
894 |
$23K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
178 |
177 |
$17K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
870 |
475 |
$11K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
847 |
832 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
43 |
28 |
$530.62 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
44 |
26 |
$524.12 |
| V2756 |
Eye glass case |
457 |
447 |
$481.68 |