| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,240 |
2,102 |
$261K |
| V2020 |
Frames, purchases |
4,713 |
4,156 |
$191K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,881 |
1,779 |
$180K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,014 |
1,805 |
$103K |
| 92015 |
Determination of refractive state |
4,520 |
4,229 |
$67K |
| V2207 |
Spherocylinder, bifocal, plus or minus 4.25 to plus or minus 7.00d sphere,.12 to 2.00d cylinder, per lens |
229 |
194 |
$18K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
171 |
157 |
$6K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
111 |
107 |
$3K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
31 |
25 |
$2K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
19 |
16 |
$864.00 |
| V2755 |
U-v lens, per lens |
27 |
25 |
$439.04 |