| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
159 |
147 |
$12K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
294 |
258 |
$3K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
77 |
75 |
$2K |
| 92342 |
|
212 |
210 |
$821.78 |
| 92341 |
|
41 |
41 |
$221.80 |
| V2020 |
Frames, purchases |
372 |
347 |
$109.48 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
194 |
143 |
$0.00 |
| V2756 |
Eye glass case |
154 |
154 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
136 |
133 |
$0.00 |
| 3072F |
|
16 |
16 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
32 |
16 |
$0.00 |
| 2022F |
|
63 |
62 |
$0.00 |
| 92015 |
Determination of refractive state |
333 |
299 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
16 |
16 |
$0.00 |