| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
269 |
260 |
$30K |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
44 |
42 |
$6K |
| V2020 |
Frames, purchases |
68 |
66 |
$3K |
| V2755 |
U-v lens, per lens |
56 |
55 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
80 |
79 |
$2K |
| V2750 |
Anti-reflective coating, per lens |
57 |
55 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
55 |
54 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$437.94 |
| 92015 |
Determination of refractive state |
17 |
14 |
$61.28 |
| S9986 |
Not medically necessary service (patient is aware that service not medically necessary) |
16 |
13 |
$0.00 |