| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
761 |
681 |
$52K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
588 |
535 |
$51K |
| V2020 |
Frames, purchases |
1,510 |
1,370 |
$47K |
| 92015 |
Determination of refractive state |
2,039 |
1,843 |
$25K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
383 |
315 |
$12K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
32 |
30 |
$663.90 |
| V2760 |
Scratch resistant coating, per lens |
16 |
15 |
$12.00 |