| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
973 |
961 |
$37K |
| V2020 |
Frames, purchases |
777 |
747 |
$12K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
435 |
416 |
$9K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
145 |
139 |
$1K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
25 |
25 |
$1K |
| 92015 |
Determination of refractive state |
1,118 |
1,105 |
$354.11 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
23 |
12 |
$230.00 |
| 3078F |
|
26 |
26 |
$0.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
20 |
20 |
$0.00 |
| 3074F |
|
26 |
26 |
$0.00 |