| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,888 |
2,770 |
$268K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,055 |
1,953 |
$220K |
| 92015 |
Determination of refractive state |
4,866 |
4,250 |
$25K |
| V2020 |
Frames, purchases |
39 |
39 |
$2K |
| V2025 |
Deluxe frame |
12 |
12 |
$388.90 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
12 |
12 |
$236.12 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
12 |
12 |
$175.83 |