| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
397 |
383 |
$24K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
206 |
194 |
$18K |
| V2020 |
Frames, purchases |
575 |
495 |
$11K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
175 |
143 |
$3K |
| V2101 |
Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens |
13 |
13 |
$331.76 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
13 |
12 |
$306.24 |
| 92015 |
Determination of refractive state |
98 |
97 |
$15.05 |