| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,457 |
2,402 |
$150K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,611 |
1,581 |
$141K |
| V2020 |
Frames, purchases |
1,753 |
1,696 |
$44K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
334 |
323 |
$8K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
25 |
25 |
$958.15 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
40 |
39 |
$958.10 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
39 |
37 |
$294.28 |
| 92015 |
Determination of refractive state |
154 |
138 |
$90.30 |