| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,733 |
2,383 |
$91K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,242 |
1,090 |
$63K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,146 |
1,731 |
$56K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
989 |
778 |
$24K |
| V2020 |
Frames, purchases |
2,691 |
2,345 |
$17K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
3,264 |
2,775 |
$12K |
| 92015 |
Determination of refractive state |
3,627 |
3,165 |
$12K |
| V2599 |
Contact lens, other type |
12 |
12 |
$2K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
33 |
28 |
$997.50 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
306 |
264 |
$282.00 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
14 |
12 |
$154.00 |
| V2025 |
Deluxe frame |
931 |
751 |
$0.00 |
| 2021F |
|
102 |
102 |
$0.00 |
| V2756 |
Eye glass case |
131 |
131 |
$0.00 |
| 92342 |
|
131 |
131 |
$0.00 |