| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
597 |
502 |
$40K |
| V2020 |
Frames, purchases |
670 |
575 |
$31K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
243 |
176 |
$6K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
122 |
79 |
$2K |
| 92015 |
Determination of refractive state |
108 |
108 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
26 |
26 |
$958.05 |