| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
847 |
770 |
$49K |
| V2020 |
Frames, purchases |
858 |
754 |
$18K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
80 |
57 |
$5K |
| 92250 |
|
59 |
57 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
99 |
82 |
$2K |
| V2756 |
Eye glass case |
595 |
515 |
$519.48 |
| 92015 |
Determination of refractive state |
1,297 |
1,174 |
$45.15 |