| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,058 |
1,055 |
$49K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
733 |
733 |
$49K |
| V2020 |
Frames, purchases |
4,018 |
3,993 |
$47K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
2,040 |
2,039 |
$27K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,530 |
982 |
$23K |
| 92015 |
Determination of refractive state |
2,047 |
2,025 |
$17K |
| 92341 |
|
739 |
734 |
$13K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
634 |
631 |
$10K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
324 |
205 |
$10K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
983 |
893 |
$9K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
421 |
397 |
$8K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,115 |
634 |
$7K |
| 2023F |
|
457 |
455 |
$0.00 |
| V2755 |
U-v lens, per lens |
310 |
154 |
$0.00 |