| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
663 |
627 |
$45K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,137 |
1,067 |
$42K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,131 |
1,069 |
$42K |
| 92015 |
Determination of refractive state |
1,848 |
1,765 |
$9K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,470 |
1,380 |
$8K |
| V2020 |
Frames, purchases |
985 |
928 |
$6K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
49 |
45 |
$2K |
| V2750 |
Anti-reflective coating, per lens |
15 |
12 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
155 |
149 |
$0.00 |
| V2025 |
Deluxe frame |
579 |
526 |
$-116.00 |