| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
727 |
690 |
$65K |
| V2020 |
Frames, purchases |
663 |
649 |
$37K |
| 92015 |
Determination of refractive state |
1,231 |
1,165 |
$17K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
107 |
107 |
$10K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
174 |
172 |
$9K |
| V2755 |
U-v lens, per lens |
178 |
175 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
105 |
105 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
42 |
42 |
$162.00 |