| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
377 |
368 |
$36K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
279 |
270 |
$31K |
| V2020 |
Frames, purchases |
455 |
442 |
$28K |
| V2199 |
Not otherwise classified, single vision lens |
477 |
464 |
$16K |
| 92015 |
Determination of refractive state |
1,230 |
1,185 |
$13K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
63 |
58 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
12 |
12 |
$0.00 |