| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
697 |
689 |
$34K |
| 92250 |
|
700 |
699 |
$33K |
| 92286 |
|
351 |
351 |
$26K |
| V2020 |
Frames, purchases |
1,251 |
1,241 |
$21K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
113 |
112 |
$6K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
262 |
262 |
$6K |
| 92083 |
|
24 |
24 |
$1K |
| 92285 |
|
55 |
55 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
39 |
38 |
$580.00 |
| 92015 |
Determination of refractive state |
40 |
39 |
$513.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
59 |
59 |
$429.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
15 |
15 |
$207.45 |