| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
508 |
427 |
$30K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
154 |
151 |
$4K |
| V2020 |
Frames, purchases |
149 |
146 |
$3K |
| 92015 |
Determination of refractive state |
1,123 |
933 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
64 |
43 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
150 |
147 |
$915.57 |