| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
199 |
187 |
$19K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
105 |
96 |
$10K |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
51 |
42 |
$10K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
51 |
42 |
$4K |
| V2750 |
Anti-reflective coating, per lens |
51 |
42 |
$2K |
| V2020 |
Frames, purchases |
19 |
13 |
$1K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
36 |
29 |
$876.81 |
| 92015 |
Determination of refractive state |
345 |
315 |
$153.96 |