| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,334 |
1,170 |
$44K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
911 |
716 |
$19K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
179 |
171 |
$9K |
| 92015 |
Determination of refractive state |
1,592 |
1,385 |
$7K |
| V2020 |
Frames, purchases |
1,180 |
1,013 |
$6K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,430 |
1,236 |
$6K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
62 |
48 |
$451.50 |
| 92342 |
|
94 |
93 |
$0.00 |
| V2756 |
Eye glass case |
82 |
81 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
13 |
12 |
$0.00 |
| V2025 |
Deluxe frame |
172 |
154 |
$0.00 |
| 2021F |
|
20 |
20 |
$0.00 |