| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
897 |
880 |
$58K |
| V2020 |
Frames, purchases |
742 |
702 |
$18K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
160 |
156 |
$15K |
| V2110 |
Spherocylinder, single vision, plus or minus 4.25 to 7.00d sphere, over 6.00d cylinder, per lens |
318 |
161 |
$8K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
42 |
38 |
$865.40 |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
12 |
12 |
$584.28 |
| V2756 |
Eye glass case |
273 |
265 |
$284.04 |