| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,963 |
2,947 |
$212K |
| V2020 |
Frames, purchases |
3,691 |
3,688 |
$175K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,117 |
2,114 |
$112K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,196 |
1,191 |
$71K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
526 |
526 |
$52K |
| 92015 |
Determination of refractive state |
1,650 |
1,637 |
$16K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
919 |
919 |
$15K |
| V2025 |
Deluxe frame |
144 |
144 |
$8K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
500 |
500 |
$6K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
79 |
79 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
125 |
125 |
$3K |
| 92310 |
|
12 |
12 |
$996.00 |
| V2750 |
Anti-reflective coating, per lens |
24 |
24 |
$795.00 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
13 |
13 |
$608.00 |
| 92341 |
|
13 |
12 |
$201.40 |
| V2781 |
Progressive lens, per lens |
12 |
12 |
$175.00 |