| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
3,847 |
3,213 |
$175K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
4,538 |
3,870 |
$126K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,833 |
2,526 |
$101K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,228 |
1,878 |
$98K |
| V2025 |
Deluxe frame |
3,219 |
2,502 |
$82K |
| 92015 |
Determination of refractive state |
4,838 |
4,219 |
$79K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
910 |
676 |
$41K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
967 |
549 |
$25K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,163 |
1,037 |
$9K |
| V2020 |
Frames, purchases |
666 |
614 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
225 |
214 |
$7.00 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
18 |
15 |
$0.00 |
| V2760 |
Scratch resistant coating, per lens |
29 |
15 |
$0.00 |