| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
439 |
429 |
$18K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
392 |
377 |
$16K |
| V2020 |
Frames, purchases |
756 |
648 |
$15K |
| V2199 |
Not otherwise classified, single vision lens |
142 |
58 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
136 |
58 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
28 |
13 |
$748.72 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
282 |
113 |
$630.00 |
| 92015 |
Determination of refractive state |
272 |
263 |
$0.00 |