| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,709 |
1,591 |
$105K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,424 |
2,203 |
$97K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,245 |
2,062 |
$78K |
| V2020 |
Frames, purchases |
2,786 |
2,539 |
$30K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
3,353 |
3,058 |
$22K |
| 92015 |
Determination of refractive state |
3,898 |
3,593 |
$20K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
435 |
409 |
$11K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
296 |
277 |
$9K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
55 |
53 |
$3K |
| V2599 |
Contact lens, other type |
13 |
13 |
$2K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$918.50 |
| 92341 |
|
43 |
40 |
$58.00 |
| V2750 |
Anti-reflective coating, per lens |
113 |
106 |
$0.00 |
| V2025 |
Deluxe frame |
1,093 |
1,021 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
273 |
258 |
$0.00 |
| 92310 |
|
27 |
26 |
$0.00 |