| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
439 |
411 |
$44K |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
19 |
17 |
$3K |
| 92250 |
|
25 |
25 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
19 |
18 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
16 |
15 |
$888.65 |
| V2750 |
Anti-reflective coating, per lens |
20 |
19 |
$488.32 |
| V2755 |
U-v lens, per lens |
20 |
19 |
$463.68 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
20 |
19 |
$404.16 |
| 92015 |
Determination of refractive state |
197 |
184 |
$30.64 |