| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,873 |
1,657 |
$247K |
| V2020 |
Frames, purchases |
1,181 |
1,072 |
$92K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
989 |
980 |
$84K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,424 |
742 |
$49K |
| 92015 |
Determination of refractive state |
1,898 |
1,676 |
$32K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
404 |
236 |
$15K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
365 |
218 |
$13K |
| V2783 |
Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens |
53 |
53 |
$7K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
18 |
18 |
$2K |
| V2750 |
Anti-reflective coating, per lens |
67 |
67 |
$968.86 |