| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,434 |
1,427 |
$54K |
| V2020 |
Frames, purchases |
2,635 |
2,489 |
$40K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,078 |
1,066 |
$36K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,485 |
1,432 |
$31K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,427 |
1,321 |
$14K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
424 |
407 |
$6K |
| 92310 |
|
55 |
54 |
$3K |
| 92015 |
Determination of refractive state |
2,743 |
2,725 |
$1K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
12 |
12 |
$414.70 |
| V2101 |
Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens |
14 |
14 |
$280.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$0.00 |