| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
480 |
464 |
$41K |
| V2499 |
Variable sphericity lens, other type |
420 |
368 |
$26K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
275 |
273 |
$23K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,297 |
1,042 |
$18K |
| 92015 |
Determination of refractive state |
1,151 |
1,098 |
$10K |
| V2020 |
Frames, purchases |
440 |
386 |
$7K |
| V2755 |
U-v lens, per lens |
425 |
369 |
$1K |
| V2750 |
Anti-reflective coating, per lens |
20 |
18 |
$150.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
28 |
14 |
$51.60 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
19 |
17 |
$27.75 |