| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
961 |
958 |
$26K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,539 |
769 |
$24K |
| V2020 |
Frames, purchases |
1,526 |
1,522 |
$14K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
104 |
52 |
$698.36 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
24 |
12 |
$693.48 |
| 92250 |
|
124 |
124 |
$199.48 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
70 |
35 |
$0.00 |
| 92015 |
Determination of refractive state |
140 |
140 |
$0.00 |