| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,197 |
1,196 |
$38K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,933 |
1,066 |
$30K |
| V2020 |
Frames, purchases |
1,740 |
1,735 |
$23K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
443 |
223 |
$94.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
26 |
13 |
$82.16 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
26 |
26 |
$40.00 |