| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,037 |
1,029 |
$61K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
198 |
197 |
$30K |
| 92015 |
Determination of refractive state |
567 |
567 |
$11K |
| V2020 |
Frames, purchases |
446 |
443 |
$10K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
78 |
78 |
$10K |
| 92002 |
|
17 |
17 |
$1K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
12 |
12 |
$987.14 |