| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,316 |
1,282 |
$130K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,894 |
1,816 |
$31K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,866 |
1,816 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
30 |
30 |
$3K |
| V2020 |
Frames, purchases |
2,170 |
2,086 |
$3K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
189 |
178 |
$3K |
| 92015 |
Determination of refractive state |
1,572 |
1,538 |
$741.36 |
| 92341 |
|
199 |
194 |
$548.04 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,562 |
1,483 |
$454.22 |
| V2025 |
Deluxe frame |
12 |
12 |
$87.50 |
| 92310 |
|
26 |
25 |
$0.00 |