| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,290 |
1,266 |
$88K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
682 |
653 |
$26K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,451 |
1,423 |
$19K |
| V2020 |
Frames, purchases |
628 |
610 |
$14K |
| 92015 |
Determination of refractive state |
1,045 |
1,028 |
$14K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
345 |
344 |
$5K |
| 92250 |
|
90 |
89 |
$4K |
| 92025 |
|
158 |
157 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
450 |
424 |
$4K |
| 92083 |
|
29 |
29 |
$2K |
| 92285 |
|
90 |
89 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
96 |
96 |
$935.55 |