| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
175 |
166 |
$16K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
174 |
150 |
$13K |
| V2020 |
Frames, purchases |
127 |
116 |
$6K |
| 92015 |
Determination of refractive state |
417 |
380 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
124 |
113 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
121 |
110 |
$2K |