| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
373 |
373 |
$16K |
| V2020 |
Frames, purchases |
776 |
554 |
$12K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
338 |
237 |
$7K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
491 |
279 |
$6K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
78 |
78 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
21 |
12 |
$420.00 |
| 92015 |
Determination of refractive state |
553 |
550 |
$0.00 |
| 92370 |
|
19 |
19 |
$0.00 |