| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
313 |
307 |
$14K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
261 |
245 |
$11K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
161 |
147 |
$1K |
| V2025 |
Deluxe frame |
159 |
150 |
$663.80 |
| V2750 |
Anti-reflective coating, per lens |
79 |
78 |
$0.00 |
| V2760 |
Scratch resistant coating, per lens |
17 |
17 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
106 |
100 |
$0.00 |
| V2755 |
U-v lens, per lens |
102 |
100 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
61 |
59 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
13 |
12 |
$0.00 |