| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,089 |
2,089 |
$20K |
| V2020 |
Frames, purchases |
2,797 |
2,788 |
$12K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,630 |
812 |
$9K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
586 |
586 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
883 |
443 |
$4K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
266 |
133 |
$976.56 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
110 |
54 |
$410.80 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
74 |
37 |
$400.12 |
| 92015 |
Determination of refractive state |
36 |
36 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,386 |
1,188 |
$0.00 |