| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,530 |
1,525 |
$55K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,515 |
761 |
$23K |
| V2020 |
Frames, purchases |
1,959 |
1,927 |
$19K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
137 |
66 |
$3K |
| 92015 |
Determination of refractive state |
1,141 |
1,139 |
$3K |
| 92202 |
|
206 |
206 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
128 |
128 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
150 |
94 |
$1K |
| 92225 |
|
18 |
18 |
$486.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
888 |
437 |
$370.24 |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
29 |
29 |
$308.00 |
| 92341 |
|
12 |
12 |
$218.16 |
| V2755 |
U-v lens, per lens |
638 |
316 |
$0.00 |