| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
25 |
15 |
$5K |
| V2025 |
Deluxe frame |
25 |
15 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
25 |
15 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
35 |
27 |
$1K |
| V2750 |
Anti-reflective coating, per lens |
25 |
15 |
$802.24 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
25 |
15 |
$611.11 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
17 |
12 |
$465.70 |
| 92250 |
|
15 |
12 |
$459.10 |