| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
396 |
386 |
$25K |
| 92015 |
Determination of refractive state |
1,773 |
1,695 |
$25K |
| V2020 |
Frames, purchases |
496 |
476 |
$12K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
87 |
84 |
$8K |
| 92002 |
|
24 |
24 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
52 |
51 |
$1K |
| V2756 |
Eye glass case |
397 |
386 |
$415.85 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
53 |
51 |
$130.80 |