| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
580 |
453 |
$32K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
316 |
247 |
$17K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
449 |
293 |
$5K |
| V2020 |
Frames, purchases |
639 |
412 |
$3K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
623 |
401 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
95 |
60 |
$686.42 |
| 92015 |
Determination of refractive state |
911 |
713 |
$615.00 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
65 |
39 |
$443.34 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
500 |
327 |
$80.00 |