| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
489 |
452 |
$29K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
898 |
827 |
$29K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
603 |
553 |
$27K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
293 |
256 |
$12K |
| V2020 |
Frames, purchases |
877 |
811 |
$7K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
94 |
84 |
$3K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,301 |
1,179 |
$703.00 |
| 92015 |
Determination of refractive state |
1,482 |
1,379 |
$464.50 |
| V2025 |
Deluxe frame |
564 |
506 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
75 |
67 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
199 |
186 |
$0.00 |