| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
664 |
646 |
$59K |
| V2020 |
Frames, purchases |
1,094 |
1,032 |
$46K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
284 |
272 |
$30K |
| 92015 |
Determination of refractive state |
1,485 |
1,403 |
$20K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
264 |
258 |
$10K |
| V2755 |
U-v lens, per lens |
130 |
126 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
24 |
24 |
$737.08 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
14 |
14 |
$442.23 |