| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
629 |
623 |
$58K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
580 |
575 |
$40K |
| V2020 |
Frames, purchases |
890 |
772 |
$21K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
656 |
633 |
$19K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
695 |
498 |
$9K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
669 |
609 |
$6K |
| 92015 |
Determination of refractive state |
1,248 |
1,235 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
113 |
74 |
$1K |
| V2750 |
Anti-reflective coating, per lens |
26 |
25 |
$340.22 |
| 92310 |
|
12 |
12 |
$152.29 |