| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,193 |
1,178 |
$19K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
620 |
619 |
$6K |
| V2020 |
Frames, purchases |
1,147 |
1,135 |
$1K |
| 92015 |
Determination of refractive state |
195 |
195 |
$778.80 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
381 |
374 |
$525.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
478 |
328 |
$253.84 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
12 |
12 |
$220.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
230 |
143 |
$42.00 |
| V2303 |
Spherocylinder, trifocal, plano to plus or minus 4.00d sphere, .12-2.00d cylinder, per lens |
72 |
72 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
218 |
125 |
$0.00 |