| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,110 |
1,057 |
$41K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
811 |
712 |
$18K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
321 |
311 |
$16K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
255 |
221 |
$4K |
| V2020 |
Frames, purchases |
1,151 |
1,100 |
$3K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,353 |
1,287 |
$1K |
| 92015 |
Determination of refractive state |
1,561 |
1,480 |
$181.50 |
| V2756 |
Eye glass case |
197 |
197 |
$0.00 |
| 92342 |
|
197 |
197 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
29 |
28 |
$0.00 |
| 2021F |
|
156 |
156 |
$0.00 |
| V2025 |
Deluxe frame |
243 |
230 |
$0.00 |
| 92341 |
|
12 |
12 |
$0.00 |