| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
868 |
842 |
$27K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
323 |
316 |
$14K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
700 |
677 |
$14K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
279 |
278 |
$13K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
159 |
155 |
$9K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
489 |
477 |
$9K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
104 |
102 |
$7K |
| 92341 |
|
226 |
221 |
$5K |
| 92015 |
Determination of refractive state |
344 |
337 |
$4K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
126 |
122 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
679 |
658 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
79 |
76 |
$2K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
12 |
12 |
$119.42 |
| V2756 |
Eye glass case |
77 |
77 |
$20.79 |
| 1036F |
|
287 |
284 |
$0.00 |