| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
781 |
781 |
$32K |
| V2020 |
Frames, purchases |
878 |
878 |
$28K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
356 |
356 |
$21K |
| V2730 |
Special base curve, glass or plastic, per lens |
668 |
668 |
$13K |
| 92015 |
Determination of refractive state |
944 |
944 |
$10K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
694 |
694 |
$9K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
197 |
197 |
$8K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
140 |
140 |
$6K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
459 |
459 |
$5K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
18 |
18 |
$2K |
| V2025 |
Deluxe frame |
78 |
78 |
$842.40 |