| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
459 |
440 |
$47K |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
273 |
249 |
$45K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
380 |
342 |
$43K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
304 |
277 |
$33K |
| V2025 |
Deluxe frame |
219 |
193 |
$20K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
302 |
275 |
$11K |
| V2750 |
Anti-reflective coating, per lens |
248 |
223 |
$6K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
214 |
190 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
52 |
44 |
$3K |
| 92250 |
|
12 |
12 |
$767.76 |
| V2020 |
Frames, purchases |
12 |
12 |
$432.36 |
| 92015 |
Determination of refractive state |
68 |
61 |
$120.00 |
| 99072 |
|
172 |
159 |
$21.00 |