| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
404 |
341 |
$15K |
| 92015 |
Determination of refractive state |
800 |
703 |
$5K |
| 92002 |
|
100 |
88 |
$3K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
70 |
69 |
$1K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
127 |
127 |
$929.60 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
74 |
74 |
$222.40 |
| V2020 |
Frames, purchases |
2,342 |
2,319 |
$140.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,356 |
712 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
4,018 |
2,042 |
$0.00 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
301 |
152 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,090 |
1,033 |
$0.00 |
| V2760 |
Scratch resistant coating, per lens |
570 |
278 |
$0.00 |