| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
454 |
434 |
$95K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
669 |
456 |
$50K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
145 |
144 |
$30K |
| V2020 |
Frames, purchases |
1,070 |
772 |
$7K |
| V2783 |
Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens |
641 |
433 |
$5K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
991 |
701 |
$2K |
| 92015 |
Determination of refractive state |
873 |
843 |
$595.00 |
| 92342 |
|
40 |
40 |
$43.36 |
| 3072F |
|
22 |
22 |
$0.00 |
| V2756 |
Eye glass case |
39 |
39 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
22 |
15 |
$0.00 |
| 2022F |
|
64 |
64 |
$0.00 |