| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
3,150 |
2,966 |
$132K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,359 |
1,111 |
$77K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,530 |
1,398 |
$66K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
2,511 |
2,389 |
$66K |
| 92015 |
Determination of refractive state |
4,184 |
3,986 |
$54K |
| V2025 |
Deluxe frame |
2,292 |
1,945 |
$38K |
| V2020 |
Frames, purchases |
1,287 |
1,263 |
$38K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
795 |
695 |
$36K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,690 |
1,648 |
$15K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
981 |
921 |
$12K |
| V2108 |
Spherocylinder, single vision, plus or minus 4.25d to plus or minus 7.00d sphere, 2.12 to 4.00d cylinder, per lens |
481 |
463 |
$6K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
90 |
89 |
$4K |
| 92341 |
|
28 |
27 |
$697.76 |