| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,028 |
2,024 |
$90K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
4,466 |
2,354 |
$81K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,410 |
1,409 |
$68K |
| 92250 |
|
713 |
713 |
$34K |
| V2020 |
Frames, purchases |
2,888 |
2,837 |
$33K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,640 |
1,629 |
$25K |
| 92015 |
Determination of refractive state |
2,809 |
2,803 |
$19K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,524 |
1,325 |
$1K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
46 |
24 |
$936.62 |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
13 |
13 |
$596.32 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
56 |
28 |
$575.12 |
| V2755 |
U-v lens, per lens |
432 |
216 |
$0.00 |