| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
574 |
559 |
$23K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
733 |
685 |
$22K |
| V2020 |
Frames, purchases |
522 |
513 |
$9K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
221 |
218 |
$5K |
| 92015 |
Determination of refractive state |
123 |
116 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
12 |
12 |
$156.00 |