| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
318 |
304 |
$16K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
245 |
232 |
$12K |
| V2020 |
Frames, purchases |
534 |
501 |
$10K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
415 |
364 |
$7K |
| 92015 |
Determination of refractive state |
754 |
714 |
$6K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
179 |
164 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
41 |
37 |
$568.32 |