| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
726 |
688 |
$43K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
176 |
163 |
$14K |
| V2020 |
Frames, purchases |
565 |
517 |
$13K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
98 |
82 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
52 |
51 |
$1K |
| V2756 |
Eye glass case |
25 |
25 |
$27.00 |
| 92015 |
Determination of refractive state |
333 |
317 |
$0.00 |