| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,538 |
1,537 |
$80K |
| V2020 |
Frames, purchases |
1,066 |
1,065 |
$55K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
544 |
541 |
$30K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
303 |
303 |
$14K |
| V2025 |
Deluxe frame |
106 |
106 |
$6K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
168 |
168 |
$2K |
| 92310 |
|
25 |
24 |
$2K |
| V2760 |
Scratch resistant coating, per lens |
175 |
175 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
14 |
14 |
$349.00 |
| 92015 |
Determination of refractive state |
123 |
123 |
$0.00 |