| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
908 |
672 |
$58K |
| V2020 |
Frames, purchases |
1,487 |
1,001 |
$34K |
| 92015 |
Determination of refractive state |
2,211 |
1,617 |
$20K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
577 |
258 |
$12K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
60 |
51 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
262 |
81 |
$2K |
| 92002 |
|
23 |
13 |
$887.92 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
21 |
20 |
$447.84 |