| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,642 |
1,232 |
$58K |
| 92250 |
|
606 |
595 |
$19K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
923 |
452 |
$14K |
| V2020 |
Frames, purchases |
1,094 |
1,071 |
$10K |
| V2782 |
Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens |
40 |
38 |
$2K |
| 99243 |
|
626 |
557 |
$356.35 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
24 |
24 |
$310.50 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
38 |
19 |
$205.40 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
13 |
13 |
$160.00 |
| 92015 |
Determination of refractive state |
13 |
13 |
$144.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
190 |
94 |
$0.00 |