| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,114 |
2,110 |
$98K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,487 |
2,236 |
$79K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
792 |
792 |
$47K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,156 |
1,987 |
$45K |
| V2020 |
Frames, purchases |
4,377 |
3,972 |
$31K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
578 |
560 |
$16K |
| 92310 |
|
99 |
99 |
$3K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
64 |
56 |
$2K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
41 |
39 |
$2K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
27 |
27 |
$1K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
14 |
14 |
$400.00 |
| 92015 |
Determination of refractive state |
36 |
36 |
$162.00 |