| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
345 |
333 |
$26K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
642 |
597 |
$10K |
| V2750 |
Anti-reflective coating, per lens |
90 |
87 |
$8K |
| 92015 |
Determination of refractive state |
813 |
764 |
$6K |
| V2499 |
Variable sphericity lens, other type |
53 |
47 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
42 |
40 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
106 |
102 |
$2K |
| V2020 |
Frames, purchases |
160 |
151 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
71 |
64 |
$998.30 |