| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,710 |
2,120 |
$73K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
701 |
677 |
$59K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
100 |
100 |
$13K |
| V2020 |
Frames, purchases |
837 |
746 |
$5K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
557 |
334 |
$4K |
| 92341 |
|
95 |
75 |
$910.95 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
29 |
29 |
$445.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
325 |
277 |
$166.98 |
| V2025 |
Deluxe frame |
798 |
718 |
$73.00 |
| 92015 |
Determination of refractive state |
58 |
58 |
$43.11 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
67 |
44 |
$0.00 |
| 2022F |
|
106 |
106 |
$0.00 |
| G0117 |
Glaucoma screening for high risk patients furnished by an optometrist or ophthalmologist |
28 |
28 |
$0.00 |
| 92342 |
|
70 |
70 |
$0.00 |
| 3072F |
|
61 |
61 |
$0.00 |
| V2756 |
Eye glass case |
70 |
70 |
$0.00 |
| 2019F |
|
63 |
56 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
31 |
18 |
$0.00 |