| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,809 |
1,802 |
$24K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
395 |
395 |
$16K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
757 |
752 |
$13K |
| V2020 |
Frames, purchases |
1,496 |
1,488 |
$9K |
| 92002 |
|
243 |
243 |
$8K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
475 |
403 |
$6K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
384 |
382 |
$4K |
| 92015 |
Determination of refractive state |
226 |
226 |
$3K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
107 |
107 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
310 |
171 |
$1K |
| V2199 |
Not otherwise classified, single vision lens |
196 |
97 |
$1K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
14 |
14 |
$784.00 |
| 92341 |
|
12 |
12 |
$216.00 |
| V2755 |
U-v lens, per lens |
134 |
67 |
$0.00 |