| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,113 |
1,112 |
$75K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,166 |
1,728 |
$46K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
749 |
748 |
$44K |
| V2020 |
Frames, purchases |
3,422 |
3,335 |
$44K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
966 |
958 |
$13K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
228 |
110 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
346 |
277 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
669 |
340 |
$1K |
| 92015 |
Determination of refractive state |
111 |
111 |
$1K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
84 |
83 |
$1K |
| V2782 |
Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens |
13 |
13 |
$768.04 |