| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,085 |
1,067 |
$50K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,230 |
1,192 |
$38K |
| V2020 |
Frames, purchases |
584 |
573 |
$36K |
| V2025 |
Deluxe frame |
689 |
686 |
$31K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
691 |
687 |
$29K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
183 |
183 |
$10K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
13 |
13 |
$78.00 |
| V2750 |
Anti-reflective coating, per lens |
13 |
13 |
$16.77 |
| 92015 |
Determination of refractive state |
1,614 |
1,598 |
$0.00 |
| 99199 |
Unlisted special service, procedure or report |
17 |
17 |
$0.00 |