| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
496 |
483 |
$34K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
286 |
283 |
$26K |
| V2020 |
Frames, purchases |
606 |
577 |
$18K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
637 |
627 |
$17K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
885 |
478 |
$9K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
362 |
324 |
$2K |
| V2760 |
Scratch resistant coating, per lens |
379 |
372 |
$602.00 |
| V2750 |
Anti-reflective coating, per lens |
25 |
24 |
$246.74 |
| 92015 |
Determination of refractive state |
920 |
899 |
$181.98 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
16 |
14 |
$103.72 |