| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
402 |
324 |
$387.96 |
| 92015 |
Determination of refractive state |
475 |
371 |
$152.16 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
544 |
448 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
646 |
533 |
$0.00 |
| V2744 |
Tint, photochromatic, per lens |
29 |
29 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
33 |
26 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
90 |
83 |
$0.00 |
| V2020 |
Frames, purchases |
923 |
743 |
$0.00 |