| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,078 |
1,022 |
$87K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,353 |
1,286 |
$75K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,427 |
1,301 |
$22K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
726 |
662 |
$11K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
2,320 |
2,168 |
$7K |
| V2020 |
Frames, purchases |
2,146 |
2,002 |
$4K |
| 92015 |
Determination of refractive state |
2,233 |
2,119 |
$539.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
120 |
115 |
$28.00 |
| V2025 |
Deluxe frame |
313 |
294 |
$0.00 |
| 2021F |
|
13 |
13 |
$0.00 |
| 92342 |
|
12 |
12 |
$0.00 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
16 |
12 |
$0.00 |
| V2756 |
Eye glass case |
12 |
12 |
$0.00 |