| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
929 |
929 |
$106K |
| V2020 |
Frames, purchases |
2,404 |
2,364 |
$103K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
619 |
619 |
$60K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
820 |
813 |
$44K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
252 |
250 |
$20K |
| 92015 |
Determination of refractive state |
565 |
565 |
$9K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
312 |
310 |
$7K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
62 |
60 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
13 |
13 |
$646.02 |