| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,943 |
1,866 |
$99K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
595 |
565 |
$26K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
423 |
402 |
$10K |
| V2020 |
Frames, purchases |
433 |
409 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
126 |
121 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
28 |
15 |
$338.10 |
| 92015 |
Determination of refractive state |
97 |
88 |
$145.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
23 |
23 |
$0.00 |