| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
4,395 |
4,182 |
$314K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,601 |
2,501 |
$230K |
| V2020 |
Frames, purchases |
1,604 |
1,600 |
$95K |
| 92015 |
Determination of refractive state |
4,842 |
4,095 |
$73K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,260 |
1,254 |
$73K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,314 |
2,305 |
$22K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
60 |
57 |
$2K |
| V2025 |
Deluxe frame |
14 |
14 |
$794.01 |
| 99199 |
Unlisted special service, procedure or report |
13 |
13 |
$0.00 |