| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,184 |
1,175 |
$50K |
| V2020 |
Frames, purchases |
1,596 |
1,568 |
$21K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
828 |
458 |
$15K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
270 |
264 |
$12K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
602 |
316 |
$10K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,601 |
811 |
$1K |
| 92015 |
Determination of refractive state |
223 |
221 |
$589.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
14 |
13 |
$195.00 |
| V2755 |
U-v lens, per lens |
164 |
82 |
$0.00 |