| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
505 |
475 |
$28K |
| V2020 |
Frames, purchases |
990 |
838 |
$27K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
345 |
328 |
$19K |
| 92015 |
Determination of refractive state |
976 |
924 |
$688.59 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
472 |
397 |
$164.62 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
592 |
483 |
$141.54 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
49 |
44 |
$30.45 |
| V2745 |
Addition to lens; tint, any color, solid, gradient or equal, excludes photochromatic, any lens material, per lens |
31 |
27 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
19 |
19 |
$0.00 |