| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
306 |
306 |
$8K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
324 |
162 |
$6K |
| V2199 |
Not otherwise classified, single vision lens |
258 |
129 |
$2K |
| V2020 |
Frames, purchases |
361 |
361 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
12 |
12 |
$480.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
872 |
436 |
$5.00 |
| V2755 |
U-v lens, per lens |
210 |
105 |
$0.00 |
| 92015 |
Determination of refractive state |
308 |
305 |
$0.00 |
| V2760 |
Scratch resistant coating, per lens |
26 |
13 |
$0.00 |