| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
315 |
294 |
$14K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
299 |
285 |
$11K |
| V2020 |
Frames, purchases |
746 |
707 |
$9K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
220 |
158 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
166 |
127 |
$2K |
| V2219 |
Bifocal seg width over 28 mm |
14 |
13 |
$871.20 |
| 92250 |
|
12 |
12 |
$554.90 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
36 |
34 |
$372.00 |
| 92225 |
|
16 |
15 |
$359.97 |
| 92341 |
|
13 |
12 |
$120.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
18 |
12 |
$104.00 |