| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
228 |
214 |
$10K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
128 |
122 |
$5K |
| V2020 |
Frames, purchases |
248 |
237 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
196 |
188 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
99 |
96 |
$1K |
| V2782 |
Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens |
15 |
15 |
$80.00 |
| 92015 |
Determination of refractive state |
365 |
345 |
$20.83 |