| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,731 |
2,730 |
$135K |
| V2020 |
Frames, purchases |
2,310 |
2,310 |
$93K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,458 |
1,458 |
$77K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,234 |
1,232 |
$69K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
423 |
423 |
$8K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
39 |
39 |
$2K |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
14 |
14 |
$2K |
| V2760 |
Scratch resistant coating, per lens |
107 |
107 |
$861.45 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
13 |
13 |
$687.50 |
| 92015 |
Determination of refractive state |
476 |
476 |
$10.00 |