| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,165 |
2,162 |
$65K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,229 |
1,593 |
$49K |
| V2020 |
Frames, purchases |
2,512 |
2,481 |
$26K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
530 |
260 |
$11K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
236 |
118 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,712 |
847 |
$0.00 |
| 92015 |
Determination of refractive state |
79 |
78 |
$0.00 |