| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
3,251 |
3,113 |
$283K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
4,218 |
3,956 |
$255K |
| V2020 |
Frames, purchases |
5,719 |
4,891 |
$123K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,821 |
2,465 |
$49K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,160 |
1,030 |
$24K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
227 |
204 |
$7K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
195 |
171 |
$5K |
| 92250 |
|
114 |
108 |
$3K |
| V2756 |
Eye glass case |
2,498 |
2,354 |
$3K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
13 |
13 |
$229.68 |
| 92015 |
Determination of refractive state |
914 |
891 |
$0.00 |
| 2022F |
|
12 |
12 |
$0.00 |