| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
765 |
719 |
$23K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
551 |
474 |
$19K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
186 |
177 |
$10K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
28 |
28 |
$2K |
| V2020 |
Frames, purchases |
528 |
505 |
$1K |
| 92015 |
Determination of refractive state |
959 |
899 |
$220.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
834 |
781 |
$105.50 |
| V2756 |
Eye glass case |
16 |
16 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
56 |
55 |
$0.00 |
| 92342 |
|
16 |
16 |
$0.00 |
| V2025 |
Deluxe frame |
264 |
240 |
$0.00 |
| 2021F |
|
13 |
13 |
$0.00 |