| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
392 |
358 |
$19K |
| V2020 |
Frames, purchases |
852 |
746 |
$16K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
112 |
82 |
$4K |
| 92015 |
Determination of refractive state |
808 |
707 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
354 |
206 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
366 |
216 |
$3K |