| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,024 |
1,023 |
$44K |
| V2020 |
Frames, purchases |
2,031 |
2,023 |
$34K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
681 |
681 |
$29K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,154 |
1,148 |
$19K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
158 |
158 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
281 |
278 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
154 |
149 |
$3K |
| 92341 |
|
53 |
53 |
$1K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
81 |
81 |
$1K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
12 |
12 |
$261.24 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
13 |
12 |
$120.00 |
| 92015 |
Determination of refractive state |
296 |
296 |
$0.00 |
| V2744 |
Tint, photochromatic, per lens |
27 |
27 |
$0.00 |