| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
241 |
224 |
$15K |
| V2020 |
Frames, purchases |
226 |
212 |
$7K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
64 |
57 |
$5K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
197 |
187 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
150 |
140 |
$3K |
| V2755 |
U-v lens, per lens |
57 |
54 |
$649.95 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
73 |
67 |
$460.25 |
| 92015 |
Determination of refractive state |
108 |
89 |
$252.42 |
| V2760 |
Scratch resistant coating, per lens |
61 |
55 |
$134.80 |