| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
374 |
347 |
$24K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
391 |
375 |
$22K |
| V2020 |
Frames, purchases |
603 |
561 |
$5K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
507 |
473 |
$2K |
| 92341 |
|
70 |
69 |
$587.50 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
294 |
257 |
$322.08 |
| 92015 |
Determination of refractive state |
564 |
529 |
$238.06 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
78 |
74 |
$90.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
114 |
82 |
$47.18 |
| 2019F |
|
30 |
30 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
15 |
12 |
$0.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
17 |
13 |
$0.00 |
| G0117 |
Glaucoma screening for high risk patients furnished by an optometrist or ophthalmologist |
41 |
41 |
$0.00 |
| 2022F |
|
14 |
14 |
$0.00 |