| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
636 |
623 |
$42K |
| V2020 |
Frames, purchases |
625 |
613 |
$23K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
238 |
235 |
$21K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
509 |
500 |
$16K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
331 |
327 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
425 |
413 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
97 |
91 |
$1K |
| V2760 |
Scratch resistant coating, per lens |
350 |
344 |
$677.59 |
| 92015 |
Determination of refractive state |
83 |
82 |
$404.40 |