| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,576 |
1,574 |
$111K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,186 |
1,186 |
$77K |
| V2020 |
Frames, purchases |
1,400 |
1,393 |
$49K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,229 |
1,065 |
$46K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
2,425 |
2,408 |
$45K |
| 92015 |
Determination of refractive state |
3,073 |
3,071 |
$26K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
79 |
77 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
43 |
41 |
$964.00 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
12 |
12 |
$569.00 |
| V2760 |
Scratch resistant coating, per lens |
14 |
14 |
$140.00 |