| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,071 |
2,070 |
$56K |
| V2020 |
Frames, purchases |
2,758 |
2,635 |
$53K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,536 |
1,676 |
$49K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
742 |
356 |
$14K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
132 |
132 |
$3K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
28 |
28 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
164 |
82 |
$575.12 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,994 |
930 |
$80.00 |
| V2755 |
U-v lens, per lens |
712 |
349 |
$0.00 |