| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,440 |
2,436 |
$53K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
4,040 |
2,029 |
$51K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,308 |
1,300 |
$36K |
| V2020 |
Frames, purchases |
2,906 |
2,865 |
$21K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,105 |
597 |
$7K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
64 |
32 |
$1K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
57 |
57 |
$960.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
12 |
12 |
$180.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
3,047 |
1,511 |
$0.00 |
| V2755 |
U-v lens, per lens |
608 |
304 |
$0.00 |