| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,074 |
1,070 |
$48K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
372 |
361 |
$18K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
561 |
149 |
$15K |
| V2020 |
Frames, purchases |
343 |
184 |
$9K |
| V2520 |
Contact lens, hydrophilic, spherical, per lens |
83 |
83 |
$7K |
| 92015 |
Determination of refractive state |
1,126 |
1,122 |
$6K |
| 92310 |
|
76 |
76 |
$4K |
| V2521 |
Contact lens, hydrophilic, toric, or prism ballast, per lens |
24 |
24 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
143 |
143 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
234 |
62 |
$120.00 |