| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,395 |
1,243 |
$47K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,036 |
855 |
$31K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
203 |
158 |
$9K |
| V2020 |
Frames, purchases |
1,263 |
1,117 |
$8K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,538 |
1,330 |
$7K |
| 92015 |
Determination of refractive state |
1,736 |
1,526 |
$7K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
103 |
80 |
$1K |
| 92342 |
|
29 |
29 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
52 |
38 |
$0.00 |
| V2756 |
Eye glass case |
29 |
29 |
$0.00 |
| V2025 |
Deluxe frame |
383 |
309 |
$0.00 |
| 2021F |
|
26 |
26 |
$0.00 |