| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,165 |
1,156 |
$48K |
| V2020 |
Frames, purchases |
1,189 |
1,177 |
$19K |
| 92250 |
|
306 |
305 |
$13K |
| 92285 |
|
205 |
205 |
$12K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
84 |
51 |
$1K |
| 92015 |
Determination of refractive state |
39 |
39 |
$796.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
34 |
33 |
$644.64 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
39 |
39 |
$462.50 |
| 92060 |
|
13 |
13 |
$399.25 |
| 92002 |
|
12 |
12 |
$330.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
48 |
48 |
$295.45 |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
79 |
41 |
$89.00 |