| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
846 |
437 |
$79K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
523 |
279 |
$64K |
| V2020 |
Frames, purchases |
1,275 |
756 |
$40K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
795 |
459 |
$36K |
| 92015 |
Determination of refractive state |
1,455 |
792 |
$23K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
247 |
134 |
$10K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
132 |
73 |
$4K |
| V2755 |
U-v lens, per lens |
226 |
147 |
$859.39 |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
25 |
24 |
$439.38 |