| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
667 |
649 |
$27K |
| V2020 |
Frames, purchases |
591 |
583 |
$11K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
414 |
411 |
$9K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
199 |
193 |
$8K |
| 92250 |
|
70 |
67 |
$3K |
| 92015 |
Determination of refractive state |
310 |
305 |
$3K |
| V2520 |
Contact lens, hydrophilic, spherical, per lens |
15 |
15 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
310 |
309 |
$2K |
| 95930 |
|
17 |
16 |
$1K |
| 92310 |
|
13 |
13 |
$978.64 |
| 92286 |
|
15 |
13 |
$519.01 |
| V2750 |
Anti-reflective coating, per lens |
23 |
23 |
$0.00 |