| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,260 |
2,100 |
$111K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,393 |
1,288 |
$83K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,702 |
1,618 |
$48K |
| 92015 |
Determination of refractive state |
3,101 |
2,893 |
$16K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
2,691 |
2,491 |
$14K |
| V2020 |
Frames, purchases |
2,111 |
1,960 |
$10K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
15 |
15 |
$1K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
12 |
12 |
$758.00 |
| 92341 |
|
14 |
14 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
15 |
15 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
277 |
269 |
$0.00 |
| 92310 |
|
38 |
38 |
$0.00 |
| V2025 |
Deluxe frame |
944 |
879 |
$-181.00 |