| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
609 |
543 |
$34K |
| V2020 |
Frames, purchases |
530 |
507 |
$21K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
418 |
197 |
$8K |
| 92015 |
Determination of refractive state |
1,245 |
1,085 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
48 |
37 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
61 |
35 |
$2K |
| V2744 |
Tint, photochromatic, per lens |
30 |
14 |
$457.02 |