| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
54 |
54 |
$6K |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
43 |
40 |
$3K |
| V2020 |
Frames, purchases |
43 |
43 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
18 |
16 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
46 |
43 |
$817.10 |
| V2755 |
U-v lens, per lens |
43 |
40 |
$621.57 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
21 |
13 |
$431.64 |
| V2750 |
Anti-reflective coating, per lens |
14 |
14 |
$213.48 |
| V2745 |
Addition to lens; tint, any color, solid, gradient or equal, excludes photochromatic, any lens material, per lens |
27 |
24 |
$135.04 |
| 92015 |
Determination of refractive state |
331 |
323 |
$9.80 |