| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
308 |
299 |
$28K |
| V2020 |
Frames, purchases |
622 |
606 |
$20K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
463 |
452 |
$14K |
| V2782 |
Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens |
446 |
442 |
$14K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
488 |
474 |
$9K |
| V2755 |
U-v lens, per lens |
448 |
445 |
$6K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
85 |
85 |
$6K |
| 92015 |
Determination of refractive state |
855 |
822 |
$2K |
| V2760 |
Scratch resistant coating, per lens |
515 |
509 |
$972.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
61 |
59 |
$464.00 |
| 92341 |
|
12 |
12 |
$401.00 |