| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,290 |
1,281 |
$71K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
944 |
940 |
$53K |
| V2020 |
Frames, purchases |
1,846 |
1,839 |
$45K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
2,049 |
2,039 |
$38K |
| 92015 |
Determination of refractive state |
2,969 |
2,948 |
$31K |
| 92341 |
|
606 |
597 |
$13K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
275 |
258 |
$5K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
398 |
284 |
$2K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
24 |
24 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
130 |
125 |
$750.80 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
30 |
24 |
$272.93 |
| 4004F |
|
24 |
24 |
$0.00 |
| 1036F |
|
1,211 |
1,209 |
$0.00 |