| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,099 |
1,844 |
$114K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,022 |
1,707 |
$50K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,057 |
964 |
$42K |
| V2020 |
Frames, purchases |
2,119 |
1,815 |
$22K |
| 92015 |
Determination of refractive state |
3,053 |
2,656 |
$20K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
2,685 |
2,275 |
$19K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
426 |
352 |
$7K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
14 |
12 |
$954.50 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
15 |
15 |
$926.00 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
16 |
13 |
$242.50 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
169 |
157 |
$56.00 |
| 92341 |
|
15 |
13 |
$0.00 |
| V2025 |
Deluxe frame |
900 |
776 |
$-236.00 |