| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,377 |
1,323 |
$96K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
964 |
925 |
$48K |
| 92015 |
Determination of refractive state |
2,698 |
2,595 |
$18K |
| V2020 |
Frames, purchases |
650 |
615 |
$13K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
550 |
482 |
$7K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
387 |
360 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
69 |
52 |
$608.00 |
| 3072F |
|
25 |
25 |
$250.00 |