| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
728 |
728 |
$37K |
| V2020 |
Frames, purchases |
880 |
878 |
$32K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
437 |
429 |
$25K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
321 |
321 |
$17K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
163 |
163 |
$2K |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
13 |
13 |
$2K |
| V2760 |
Scratch resistant coating, per lens |
50 |
50 |
$401.80 |
| 92015 |
Determination of refractive state |
74 |
74 |
$0.00 |