| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
490 |
387 |
$19K |
| V2020 |
Frames, purchases |
764 |
610 |
$12K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
512 |
421 |
$9K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
208 |
147 |
$7K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
515 |
407 |
$5K |
| 92015 |
Determination of refractive state |
902 |
716 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
27 |
27 |
$316.10 |