| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
376 |
354 |
$31K |
| V2782 |
Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens |
205 |
145 |
$28K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
358 |
322 |
$24K |
| V2025 |
Deluxe frame |
341 |
303 |
$21K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
990 |
888 |
$12K |
| V2020 |
Frames, purchases |
643 |
579 |
$10K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
552 |
485 |
$9K |
| V2760 |
Scratch resistant coating, per lens |
577 |
482 |
$8K |
| V2745 |
Addition to lens; tint, any color, solid, gradient or equal, excludes photochromatic, any lens material, per lens |
577 |
482 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
103 |
97 |
$2K |