| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
6,474 |
5,986 |
$260K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,932 |
1,885 |
$159K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
629 |
627 |
$57K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,256 |
1,125 |
$30K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,103 |
1,758 |
$22K |
| 92015 |
Determination of refractive state |
1,259 |
1,247 |
$20K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
897 |
829 |
$12K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
793 |
769 |
$10K |
| 92083 |
|
23 |
23 |
$1K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
32 |
32 |
$840.00 |
| 92250 |
|
12 |
12 |
$551.10 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
12 |
12 |
$541.60 |
| 92133 |
|
12 |
12 |
$368.48 |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
14 |
13 |
$290.00 |
| 92341 |
|
12 |
12 |
$55.00 |