| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,173 |
1,155 |
$63K |
| V2219 |
Bifocal seg width over 28 mm |
518 |
492 |
$44K |
| V2020 |
Frames, purchases |
3,113 |
3,055 |
$44K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,059 |
1,045 |
$40K |
| V2430 |
Variable asphericity lens, bifocal, full field, glass or plastic, per lens |
379 |
365 |
$24K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
925 |
626 |
$16K |
| 92341 |
|
531 |
504 |
$10K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
338 |
211 |
$6K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
156 |
133 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,509 |
898 |
$3K |
| 92250 |
|
32 |
32 |
$1K |
| 92202 |
|
37 |
37 |
$510.31 |
| 92015 |
Determination of refractive state |
19 |
19 |
$0.00 |
| V2755 |
U-v lens, per lens |
185 |
93 |
$0.00 |