| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
858 |
760 |
$71K |
| V2020 |
Frames, purchases |
1,267 |
1,091 |
$51K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
369 |
338 |
$38K |
| 92015 |
Determination of refractive state |
1,914 |
1,702 |
$25K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
196 |
183 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
135 |
118 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
31 |
17 |
$719.36 |
| V2702 |
Deluxe lens feature |
15 |
15 |
$0.00 |