| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
436 |
423 |
$39K |
| V2020 |
Frames, purchases |
862 |
777 |
$27K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
447 |
428 |
$23K |
| 92015 |
Determination of refractive state |
890 |
837 |
$13K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
119 |
115 |
$13K |
| V2755 |
U-v lens, per lens |
164 |
164 |
$5K |