| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
519 |
508 |
$27K |
| V2020 |
Frames, purchases |
912 |
885 |
$22K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
39 |
38 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
189 |
110 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
100 |
97 |
$1K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
23 |
12 |
$659.82 |
| 92015 |
Determination of refractive state |
73 |
65 |
$393.28 |