| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
678 |
678 |
$4K |
| V2020 |
Frames, purchases |
897 |
894 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
78 |
78 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
353 |
236 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
346 |
204 |
$945.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
31 |
31 |
$580.00 |
| 92015 |
Determination of refractive state |
130 |
130 |
$435.60 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
24 |
17 |
$260.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
51 |
51 |
$26.40 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
218 |
124 |
$0.00 |