| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
957 |
906 |
$57K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
862 |
787 |
$49K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
614 |
556 |
$5K |
| 92015 |
Determination of refractive state |
1,482 |
1,396 |
$2K |
| V2020 |
Frames, purchases |
42 |
42 |
$26.80 |
| V2025 |
Deluxe frame |
217 |
202 |
$25.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
28 |
28 |
$5.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
108 |
105 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
276 |
248 |
$0.00 |
| V2755 |
U-v lens, per lens |
22 |
22 |
$0.00 |
| V2760 |
Scratch resistant coating, per lens |
19 |
19 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
69 |
68 |
$0.00 |