| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
718 |
717 |
$30K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,152 |
1,152 |
$20K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,159 |
1,065 |
$19K |
| V2020 |
Frames, purchases |
2,788 |
2,746 |
$15K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
276 |
137 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
808 |
403 |
$3K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
230 |
228 |
$3K |
| 92341 |
|
147 |
147 |
$3K |
| 92225 |
|
27 |
27 |
$780.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
42 |
26 |
$366.98 |
| 92015 |
Determination of refractive state |
267 |
267 |
$334.40 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
900 |
446 |
$0.00 |