| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,708 |
2,708 |
$38K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,736 |
1,736 |
$19K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,346 |
1,344 |
$19K |
| 92015 |
Determination of refractive state |
1,785 |
1,783 |
$6K |
| 92341 |
|
106 |
106 |
$2K |
| V2020 |
Frames, purchases |
2,788 |
2,725 |
$940.00 |
| 92250 |
|
14 |
14 |
$560.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,429 |
1,708 |
$382.40 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,317 |
1,150 |
$228.00 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
682 |
341 |
$143.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
320 |
162 |
$72.00 |
| V2750 |
Anti-reflective coating, per lens |
24 |
12 |
$0.00 |