| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
614 |
611 |
$42K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
738 |
738 |
$42K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
305 |
305 |
$28K |
| V2020 |
Frames, purchases |
887 |
867 |
$7K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
981 |
742 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
643 |
626 |
$2K |
| 92250 |
|
13 |
13 |
$637.13 |
| 92370 |
|
12 |
12 |
$319.00 |
| V2760 |
Scratch resistant coating, per lens |
97 |
97 |
$194.00 |
| 92015 |
Determination of refractive state |
726 |
720 |
$80.88 |