| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
3,156 |
3,152 |
$109K |
| V2020 |
Frames, purchases |
4,555 |
4,496 |
$82K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
4,577 |
2,288 |
$70K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
1,171 |
605 |
$22K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
561 |
283 |
$3K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
119 |
66 |
$1K |
| 92341 |
|
58 |
57 |
$820.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
66 |
66 |
$810.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
930 |
458 |
$0.00 |
| 92015 |
Determination of refractive state |
2,345 |
2,339 |
$0.00 |