| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,545 |
1,415 |
$127K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
967 |
868 |
$92K |
| V2020 |
Frames, purchases |
1,996 |
1,731 |
$72K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
989 |
761 |
$35K |
| 92015 |
Determination of refractive state |
2,886 |
2,605 |
$35K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
105 |
94 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
15 |
15 |
$380.35 |