| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
396 |
388 |
$46K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
187 |
183 |
$19K |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
225 |
176 |
$16K |
| V2020 |
Frames, purchases |
224 |
176 |
$8K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
263 |
107 |
$6K |
| 92250 |
|
67 |
67 |
$4K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
225 |
176 |
$4K |
| V2750 |
Anti-reflective coating, per lens |
141 |
112 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
225 |
176 |
$2K |
| 92015 |
Determination of refractive state |
14 |
12 |
$0.00 |