| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,255 |
1,252 |
$48K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,944 |
1,446 |
$45K |
| V2020 |
Frames, purchases |
2,157 |
2,122 |
$24K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
659 |
656 |
$22K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
424 |
212 |
$8K |
| 92250 |
|
13 |
13 |
$534.00 |
| 92341 |
|
18 |
18 |
$360.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
64 |
32 |
$328.64 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
18 |
18 |
$270.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,061 |
520 |
$0.00 |
| 92015 |
Determination of refractive state |
302 |
302 |
$0.00 |