| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
555 |
549 |
$52K |
| V2020 |
Frames, purchases |
1,728 |
1,720 |
$28K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
335 |
327 |
$27K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,639 |
970 |
$18K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
349 |
231 |
$4K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
315 |
191 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,319 |
1,199 |
$2K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
12 |
12 |
$896.61 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
21 |
13 |
$280.00 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
17 |
13 |
$175.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,580 |
1,575 |
$25.00 |
| 92341 |
|
166 |
165 |
$25.00 |
| 92015 |
Determination of refractive state |
1,199 |
1,178 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
267 |
139 |
$0.00 |
| 99072 |
|
533 |
513 |
$0.00 |
| V2783 |
Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens |
253 |
129 |
$0.00 |