| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
422 |
419 |
$33K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
334 |
330 |
$21K |
| V2020 |
Frames, purchases |
839 |
829 |
$20K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
366 |
366 |
$11K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
171 |
171 |
$6K |
| 92015 |
Determination of refractive state |
1,253 |
1,235 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
448 |
369 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
213 |
129 |
$1K |
| V2750 |
Anti-reflective coating, per lens |
13 |
13 |
$0.00 |
| V2744 |
Tint, photochromatic, per lens |
15 |
15 |
$0.00 |