| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,047 |
1,011 |
$94K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,047 |
1,005 |
$69K |
| V2020 |
Frames, purchases |
1,935 |
1,680 |
$48K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,040 |
902 |
$17K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
845 |
746 |
$5K |
| 92015 |
Determination of refractive state |
115 |
113 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
12 |
12 |
$330.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
15 |
12 |
$178.00 |