| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
438 |
418 |
$16K |
| V2020 |
Frames, purchases |
2,129 |
2,101 |
$12K |
| V2199 |
Not otherwise classified, single vision lens |
1,350 |
675 |
$10K |
| 92250 |
|
175 |
175 |
$9K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
589 |
579 |
$6K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
349 |
275 |
$3K |
| 92082 |
|
56 |
56 |
$3K |
| 92285 |
|
152 |
85 |
$2K |
| 92286 |
|
17 |
17 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
116 |
97 |
$1K |
| 92002 |
|
24 |
24 |
$951.48 |
| 68801 |
|
18 |
14 |
$932.40 |
| 92083 |
|
17 |
17 |
$895.56 |
| V2299 |
Specialty bifocal (by report) |
24 |
12 |
$400.12 |
| 92025 |
|
18 |
18 |
$398.88 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
19 |
14 |
$243.46 |
| 92202 |
|
12 |
12 |
$123.72 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
58 |
29 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
78 |
39 |
$0.00 |