| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
164 |
158 |
$15K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
51 |
48 |
$6K |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
56 |
29 |
$4K |
| V2020 |
Frames, purchases |
43 |
42 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
73 |
66 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
108 |
55 |
$705.32 |
| V2750 |
Anti-reflective coating, per lens |
58 |
54 |
$623.43 |
| 92015 |
Determination of refractive state |
582 |
561 |
$514.02 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
21 |
13 |
$418.86 |
| V2755 |
U-v lens, per lens |
14 |
13 |
$277.02 |