| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
530 |
514 |
$34K |
| V2020 |
Frames, purchases |
645 |
619 |
$16K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
350 |
329 |
$9K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
84 |
84 |
$8K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
54 |
54 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
173 |
170 |
$476.40 |
| V2756 |
Eye glass case |
407 |
395 |
$423.36 |
| 92015 |
Determination of refractive state |
761 |
741 |
$75.25 |