| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
782 |
760 |
$50K |
| V2020 |
Frames, purchases |
572 |
544 |
$13K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
81 |
77 |
$7K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
130 |
121 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
42 |
42 |
$1K |
| 92370 |
|
17 |
15 |
$225.00 |
| V2756 |
Eye glass case |
139 |
134 |
$142.56 |
| 92015 |
Determination of refractive state |
180 |
171 |
$0.00 |