| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
654 |
642 |
$45K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
316 |
305 |
$19K |
| V2020 |
Frames, purchases |
358 |
358 |
$7K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
230 |
230 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
290 |
290 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
28 |
28 |
$280.72 |
| V2783 |
Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens |
12 |
12 |
$38.50 |
| 92015 |
Determination of refractive state |
272 |
272 |
$0.00 |