| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,507 |
1,480 |
$100K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
433 |
422 |
$37K |
| V2020 |
Frames, purchases |
1,118 |
1,053 |
$27K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
281 |
235 |
$6K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
183 |
173 |
$4K |
| V2756 |
Eye glass case |
284 |
283 |
$293.76 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
36 |
24 |
$72.52 |
| 92015 |
Determination of refractive state |
1,661 |
1,620 |
$0.00 |
| V2760 |
Scratch resistant coating, per lens |
27 |
27 |
$0.00 |