| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,052 |
1,042 |
$38K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,336 |
1,313 |
$28K |
| V2020 |
Frames, purchases |
1,734 |
1,706 |
$27K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,385 |
1,361 |
$15K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
304 |
303 |
$11K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
118 |
117 |
$3K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
12 |
12 |
$452.40 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
14 |
14 |
$348.32 |
| V2750 |
Anti-reflective coating, per lens |
175 |
174 |
$0.00 |
| 92015 |
Determination of refractive state |
22 |
22 |
$0.00 |