| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
639 |
621 |
$30K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
698 |
677 |
$19K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
660 |
637 |
$6K |
| V2020 |
Frames, purchases |
290 |
281 |
$6K |
| 92015 |
Determination of refractive state |
1,424 |
1,340 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
57 |
57 |
$3K |
| V2025 |
Deluxe frame |
24 |
24 |
$930.94 |