| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
450 |
414 |
$45K |
| V2020 |
Frames, purchases |
937 |
822 |
$38K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
185 |
164 |
$17K |
| 92015 |
Determination of refractive state |
1,166 |
1,050 |
$17K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
444 |
217 |
$11K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
103 |
87 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
17 |
13 |
$596.88 |