| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92015 |
Determination of refractive state |
784 |
747 |
$22K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
379 |
360 |
$10K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
41 |
41 |
$787.50 |
| V2020 |
Frames, purchases |
665 |
629 |
$433.40 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
289 |
285 |
$0.00 |
| V2744 |
Tint, photochromatic, per lens |
354 |
348 |
$0.00 |
| V2781 |
Progressive lens, per lens |
126 |
126 |
$0.00 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
41 |
41 |
$0.00 |
| V2760 |
Scratch resistant coating, per lens |
445 |
434 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
28 |
28 |
$0.00 |