| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
928 |
878 |
$31K |
| V2020 |
Frames, purchases |
1,076 |
1,036 |
$19K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
856 |
829 |
$15K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
553 |
531 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
54 |
53 |
$2K |
| 92015 |
Determination of refractive state |
203 |
180 |
$998.55 |