| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
3,041 |
2,966 |
$143K |
| V2020 |
Frames, purchases |
1,497 |
1,472 |
$95K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
828 |
827 |
$49K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
971 |
951 |
$45K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,337 |
1,303 |
$43K |
| V2025 |
Deluxe frame |
380 |
378 |
$18K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
38 |
38 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
283 |
271 |
$2K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
14 |
14 |
$736.00 |
| 92015 |
Determination of refractive state |
1,933 |
1,836 |
$151.35 |
| 92250 |
|
12 |
12 |
$0.00 |