| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
359 |
350 |
$24K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
244 |
243 |
$23K |
| V2020 |
Frames, purchases |
251 |
242 |
$8K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
233 |
227 |
$7K |
| 92015 |
Determination of refractive state |
353 |
339 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
170 |
161 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
58 |
53 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
52 |
51 |
$1K |
| 92002 |
|
19 |
19 |
$986.89 |
| V2760 |
Scratch resistant coating, per lens |
146 |
141 |
$455.00 |