| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
473 |
456 |
$48K |
| V2020 |
Frames, purchases |
513 |
497 |
$31K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
104 |
99 |
$12K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
522 |
511 |
$10K |
| 92250 |
|
772 |
730 |
$7K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
26 |
26 |
$477.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
24 |
24 |
$371.00 |