| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
3,214 |
3,123 |
$135K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,523 |
1,718 |
$61K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
3,392 |
1,336 |
$59K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
757 |
732 |
$41K |
| V2020 |
Frames, purchases |
3,609 |
2,757 |
$40K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,163 |
515 |
$25K |
| 92015 |
Determination of refractive state |
3,216 |
3,127 |
$18K |
| 92310 |
|
15 |
14 |
$672.26 |
| V2750 |
Anti-reflective coating, per lens |
77 |
55 |
$561.00 |
| V2744 |
Tint, photochromatic, per lens |
22 |
16 |
$180.00 |
| V2025 |
Deluxe frame |
204 |
178 |
$0.00 |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
142 |
96 |
$0.00 |