| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
923 |
917 |
$1K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
500 |
498 |
$812.66 |
| 92015 |
Determination of refractive state |
785 |
777 |
$223.30 |
| V2020 |
Frames, purchases |
1,174 |
1,157 |
$104.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
294 |
239 |
$68.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
28 |
24 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
421 |
275 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
466 |
294 |
$0.00 |