| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
508 |
508 |
$22K |
| V2020 |
Frames, purchases |
723 |
715 |
$12K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
477 |
471 |
$12K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
188 |
187 |
$8K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
377 |
372 |
$3K |
| 92015 |
Determination of refractive state |
924 |
922 |
$828.00 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
16 |
16 |
$603.20 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
13 |
13 |
$323.44 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
13 |
13 |
$208.00 |
| V2750 |
Anti-reflective coating, per lens |
12 |
12 |
$0.00 |