| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
180 |
157 |
$9K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
180 |
170 |
$8K |
| V2020 |
Frames, purchases |
383 |
309 |
$8K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
188 |
113 |
$2K |
| V2755 |
U-v lens, per lens |
39 |
28 |
$200.98 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
36 |
30 |
$194.01 |
| 92015 |
Determination of refractive state |
460 |
418 |
$60.66 |