| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,746 |
2,729 |
$133K |
| V2020 |
Frames, purchases |
2,159 |
2,153 |
$97K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,428 |
1,422 |
$67K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
865 |
830 |
$49K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
459 |
455 |
$15K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
739 |
731 |
$11K |
| 92250 |
|
83 |
77 |
$2K |
| V2025 |
Deluxe frame |
49 |
49 |
$2K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$1K |
| 92015 |
Determination of refractive state |
1,452 |
1,437 |
$169.13 |
| V2760 |
Scratch resistant coating, per lens |
13 |
13 |
$110.70 |