| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
727 |
727 |
$31K |
| V2020 |
Frames, purchases |
701 |
691 |
$12K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
268 |
268 |
$12K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
532 |
523 |
$11K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
348 |
339 |
$4K |
| V2025 |
Deluxe frame |
79 |
79 |
$1K |
| V2755 |
U-v lens, per lens |
260 |
260 |
$0.00 |
| 92015 |
Determination of refractive state |
1,092 |
1,092 |
$0.00 |