| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,976 |
2,959 |
$184K |
| 92250 |
|
2,047 |
2,009 |
$88K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
5,229 |
2,911 |
$83K |
| V2020 |
Frames, purchases |
4,135 |
4,108 |
$58K |
| 92285 |
|
1,546 |
1,512 |
$43K |
| 92082 |
|
522 |
521 |
$23K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
596 |
368 |
$13K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
363 |
360 |
$9K |
| 76512 |
|
64 |
32 |
$4K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
90 |
90 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,549 |
848 |
$912.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
211 |
111 |
$879.04 |
| 92225 |
|
22 |
22 |
$114.11 |
| V2755 |
U-v lens, per lens |
562 |
277 |
$0.00 |
| 92015 |
Determination of refractive state |
96 |
96 |
$0.00 |