| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,490 |
1,355 |
$92K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
587 |
564 |
$37K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,024 |
952 |
$24K |
| V2782 |
Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens |
330 |
312 |
$24K |
| V2020 |
Frames, purchases |
1,871 |
1,753 |
$15K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
579 |
541 |
$5K |
| 92015 |
Determination of refractive state |
2,037 |
1,952 |
$4K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,467 |
1,388 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
139 |
132 |
$3K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
26 |
24 |
$602.25 |
| 92250 |
|
33 |
24 |
$476.76 |
| 99072 |
|
43 |
39 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
12 |
12 |
$0.00 |