| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
933 |
793 |
$32K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
551 |
491 |
$29K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
384 |
207 |
$7K |
| 92015 |
Determination of refractive state |
1,313 |
1,185 |
$7K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
91 |
88 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
99 |
71 |
$3K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
13 |
13 |
$1K |