| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
977 |
864 |
$57K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
872 |
783 |
$40K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
634 |
541 |
$29K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
576 |
555 |
$26K |
| 92015 |
Determination of refractive state |
1,063 |
1,010 |
$18K |
| V2025 |
Deluxe frame |
691 |
539 |
$8K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
12 |
12 |
$2K |
| V2020 |
Frames, purchases |
143 |
143 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
14 |
13 |
$0.00 |