| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,837 |
1,811 |
$92K |
| V2020 |
Frames, purchases |
1,143 |
1,136 |
$40K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
681 |
633 |
$37K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
536 |
529 |
$30K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
86 |
86 |
$269.62 |
| 92015 |
Determination of refractive state |
160 |
160 |
$218.17 |