| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,197 |
1,172 |
$44K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
883 |
868 |
$33K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,448 |
1,427 |
$31K |
| V2020 |
Frames, purchases |
1,667 |
1,639 |
$28K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
968 |
952 |
$10K |
| 92310 |
|
103 |
95 |
$5K |
| 92015 |
Determination of refractive state |
2,166 |
2,123 |
$1K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
26 |
26 |
$566.02 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
12 |
12 |
$452.40 |