| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
4,196 |
4,095 |
$214K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
3,002 |
2,866 |
$145K |
| V2020 |
Frames, purchases |
1,665 |
1,653 |
$58K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
810 |
809 |
$22K |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
178 |
177 |
$17K |
| 92015 |
Determination of refractive state |
3,863 |
3,527 |
$15K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,352 |
1,340 |
$13K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
100 |
100 |
$5K |
| V2025 |
Deluxe frame |
50 |
50 |
$3K |
| 92250 |
|
14 |
12 |
$266.91 |
| V2750 |
Anti-reflective coating, per lens |
13 |
13 |
$69.45 |
| V2755 |
U-v lens, per lens |
44 |
44 |
$32.89 |
| 99199 |
Unlisted special service, procedure or report |
259 |
259 |
$0.00 |