| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
589 |
551 |
$56K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
527 |
485 |
$40K |
| V2025 |
Deluxe frame |
754 |
707 |
$21K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,000 |
929 |
$17K |
| 92015 |
Determination of refractive state |
1,467 |
1,339 |
$13K |
| V2020 |
Frames, purchases |
338 |
330 |
$6K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
118 |
117 |
$5K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
104 |
99 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
49 |
42 |
$917.34 |
| V2750 |
Anti-reflective coating, per lens |
12 |
12 |
$416.41 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
114 |
105 |
$0.00 |