| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
627 |
578 |
$39K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,032 |
905 |
$38K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,030 |
918 |
$32K |
| V2020 |
Frames, purchases |
1,188 |
1,058 |
$9K |
| 92015 |
Determination of refractive state |
1,736 |
1,573 |
$9K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,486 |
1,302 |
$8K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
42 |
37 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
64 |
59 |
$137.50 |
| V2025 |
Deluxe frame |
285 |
254 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
14 |
14 |
$0.00 |