| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
245 |
244 |
$11K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
238 |
238 |
$11K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
285 |
282 |
$7K |
| V2020 |
Frames, purchases |
468 |
410 |
$7K |
| 92015 |
Determination of refractive state |
499 |
498 |
$2K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
38 |
38 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
89 |
75 |
$772.50 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
46 |
44 |
$699.76 |