| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,787 |
1,735 |
$67K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,528 |
1,346 |
$48K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
586 |
570 |
$35K |
| V2020 |
Frames, purchases |
1,693 |
1,614 |
$10K |
| 92015 |
Determination of refractive state |
2,289 |
2,211 |
$10K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
2,058 |
1,976 |
$9K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
261 |
237 |
$8K |
| V2025 |
Deluxe frame |
449 |
429 |
$0.00 |
| 2021F |
|
28 |
28 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
12 |
12 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
197 |
194 |
$0.00 |
| V2756 |
Eye glass case |
57 |
57 |
$0.00 |
| 92342 |
|
57 |
57 |
$0.00 |