| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,963 |
1,960 |
$86K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,936 |
1,914 |
$44K |
| V2020 |
Frames, purchases |
3,063 |
3,036 |
$30K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
695 |
690 |
$9K |
| 92015 |
Determination of refractive state |
589 |
583 |
$5K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
489 |
331 |
$4K |
| 92002 |
|
77 |
77 |
$3K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
258 |
256 |
$2K |
| 92083 |
|
15 |
15 |
$877.95 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
23 |
12 |
$631.74 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,224 |
661 |
$592.00 |
| 92285 |
|
12 |
12 |
$334.40 |
| V2755 |
U-v lens, per lens |
30 |
14 |
$0.00 |