| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92015 |
Determination of refractive state |
1,097 |
943 |
$15K |
| V2020 |
Frames, purchases |
536 |
464 |
$15K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
85 |
62 |
$9K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
120 |
102 |
$6K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
114 |
103 |
$5K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
63 |
53 |
$4K |