| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
856 |
856 |
$38K |
| V2020 |
Frames, purchases |
1,861 |
1,691 |
$30K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
691 |
690 |
$30K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
974 |
877 |
$19K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,023 |
856 |
$10K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
123 |
108 |
$2K |
| 92015 |
Determination of refractive state |
1,632 |
1,631 |
$2K |
| V2755 |
U-v lens, per lens |
584 |
584 |
$10.50 |
| V2760 |
Scratch resistant coating, per lens |
27 |
27 |
$0.00 |