| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,138 |
1,136 |
$50K |
| 92015 |
Determination of refractive state |
1,652 |
1,646 |
$25K |
| V2020 |
Frames, purchases |
681 |
677 |
$24K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
482 |
475 |
$20K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
542 |
536 |
$16K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
623 |
619 |
$8K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
316 |
314 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
108 |
107 |
$3K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
19 |
19 |
$855.00 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
13 |
13 |
$114.84 |