| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
109 |
90 |
$9K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
87 |
77 |
$9K |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
66 |
29 |
$9K |
| V2020 |
Frames, purchases |
155 |
78 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
154 |
78 |
$2K |
| V2101 |
Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens |
32 |
13 |
$1K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
88 |
43 |
$1K |
| 92015 |
Determination of refractive state |
795 |
688 |
$490.03 |
| V2750 |
Anti-reflective coating, per lens |
22 |
13 |
$394.24 |