| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,292 |
2,292 |
$291.28 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
235 |
235 |
$168.69 |
| 92015 |
Determination of refractive state |
1,739 |
1,739 |
$63.60 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,030 |
1,028 |
$0.00 |
| V2299 |
Specialty bifocal (by report) |
61 |
61 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,437 |
1,434 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
882 |
879 |
$0.00 |
| V2781 |
Progressive lens, per lens |
61 |
61 |
$0.00 |
| 92250 |
|
13 |
13 |
$0.00 |
| V2020 |
Frames, purchases |
2,967 |
2,957 |
$0.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
357 |
357 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
96 |
96 |
$0.00 |