| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
353 |
313 |
$7K |
| V2020 |
Frames, purchases |
440 |
410 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
222 |
206 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
189 |
175 |
$861.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
48 |
43 |
$755.00 |
| 92015 |
Determination of refractive state |
192 |
172 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
33 |
29 |
$0.00 |