| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,876 |
1,870 |
$77K |
| V2020 |
Frames, purchases |
3,372 |
3,359 |
$54K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,209 |
1,209 |
$49K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,928 |
1,921 |
$44K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
881 |
881 |
$30K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,956 |
1,946 |
$19K |
| 92015 |
Determination of refractive state |
3,260 |
3,252 |
$1K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
26 |
25 |
$544.25 |
| 92341 |
|
13 |
13 |
$350.61 |
| V2755 |
U-v lens, per lens |
167 |
167 |
$0.00 |
| 2022F |
|
12 |
12 |
$0.00 |