| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,345 |
2,174 |
$101K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,681 |
1,575 |
$59K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
285 |
265 |
$19K |
| 92015 |
Determination of refractive state |
2,843 |
2,630 |
$15K |
| V2020 |
Frames, purchases |
2,074 |
1,911 |
$14K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
2,214 |
2,052 |
$14K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
70 |
70 |
$2K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
14 |
12 |
$836.00 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
15 |
12 |
$768.50 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
12 |
12 |
$719.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
129 |
126 |
$33.00 |
| V2025 |
Deluxe frame |
517 |
468 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
12 |
12 |
$0.00 |
| 92341 |
|
15 |
13 |
$0.00 |