| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
281 |
266 |
$16K |
| V2020 |
Frames, purchases |
207 |
202 |
$8K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
70 |
70 |
$6K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
113 |
111 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
157 |
152 |
$3K |
| 92250 |
|
25 |
24 |
$1K |
| 92015 |
Determination of refractive state |
512 |
490 |
$970.58 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
135 |
133 |
$582.51 |
| V2760 |
Scratch resistant coating, per lens |
27 |
25 |
$48.00 |