| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,983 |
1,949 |
$104K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
914 |
829 |
$40K |
| V2020 |
Frames, purchases |
1,704 |
1,644 |
$33K |
| 92015 |
Determination of refractive state |
3,859 |
3,668 |
$18K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,250 |
990 |
$10K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
305 |
296 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
207 |
136 |
$919.12 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
45 |
26 |
$655.56 |