| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
790 |
786 |
$5K |
| V2020 |
Frames, purchases |
1,781 |
1,759 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
499 |
450 |
$2K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
78 |
78 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
587 |
549 |
$372.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
337 |
324 |
$171.48 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
624 |
590 |
$164.32 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
14 |
14 |
$10.00 |
| V2755 |
U-v lens, per lens |
78 |
39 |
$0.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
828 |
826 |
$0.00 |
| 92015 |
Determination of refractive state |
86 |
85 |
$0.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
15 |
15 |
$0.00 |