| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,588 |
2,406 |
$101K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,123 |
1,921 |
$73K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,166 |
1,069 |
$68K |
| V2020 |
Frames, purchases |
3,066 |
2,765 |
$24K |
| 92015 |
Determination of refractive state |
3,570 |
3,304 |
$17K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
3,089 |
2,815 |
$16K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
615 |
549 |
$16K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
64 |
61 |
$5K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
43 |
42 |
$2K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
20 |
13 |
$789.00 |
| 92310 |
|
12 |
12 |
$35.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
270 |
264 |
$10.00 |
| V2025 |
Deluxe frame |
388 |
367 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
65 |
64 |
$0.00 |
| 92341 |
|
109 |
103 |
$0.00 |
| 92342 |
|
26 |
26 |
$0.00 |
| V2756 |
Eye glass case |
26 |
26 |
$0.00 |