| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,652 |
2,554 |
$170K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,915 |
1,880 |
$162K |
| V2020 |
Frames, purchases |
3,336 |
3,198 |
$104K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,512 |
1,384 |
$51K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,413 |
728 |
$41K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,039 |
508 |
$29K |
| 92015 |
Determination of refractive state |
4,783 |
4,641 |
$23K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
283 |
181 |
$6K |
| V2780 |
Oversize lens, per lens |
502 |
242 |
$5K |
| V2730 |
Special base curve, glass or plastic, per lens |
181 |
89 |
$3K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
20 |
13 |
$579.20 |