| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,259 |
1,186 |
$140K |
| V2499 |
Variable sphericity lens, other type |
1,741 |
1,663 |
$103K |
| V2020 |
Frames, purchases |
1,751 |
1,669 |
$32K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,591 |
1,525 |
$27K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,179 |
1,119 |
$16K |
| 92015 |
Determination of refractive state |
1,258 |
1,183 |
$10K |
| V2755 |
U-v lens, per lens |
1,748 |
1,663 |
$7K |
| 92341 |
|
104 |
90 |
$2K |
| 92134 |
|
29 |
26 |
$814.75 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
102 |
88 |
$364.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,404 |
1,326 |
$26.18 |