| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
627 |
618 |
$25K |
| V2020 |
Frames, purchases |
681 |
668 |
$11K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
520 |
515 |
$11K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
251 |
242 |
$8K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
73 |
71 |
$585.00 |
| 92015 |
Determination of refractive state |
1,176 |
1,155 |
$204.50 |