| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
701 |
619 |
$30K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
680 |
579 |
$28K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
723 |
265 |
$7K |
| 92015 |
Determination of refractive state |
1,522 |
1,330 |
$7K |
| V2020 |
Frames, purchases |
413 |
295 |
$6K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
371 |
168 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
33 |
15 |
$177.72 |