| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
682 |
653 |
$46K |
| V2020 |
Frames, purchases |
623 |
608 |
$25K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
356 |
343 |
$24K |
| 92015 |
Determination of refractive state |
765 |
743 |
$6K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
246 |
241 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
125 |
124 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$1K |
| V2025 |
Deluxe frame |
29 |
28 |
$724.55 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
37 |
37 |
$646.00 |
| V2750 |
Anti-reflective coating, per lens |
24 |
24 |
$575.55 |