| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
999 |
988 |
$41K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
919 |
909 |
$23K |
| V2020 |
Frames, purchases |
1,113 |
1,093 |
$18K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
624 |
616 |
$5K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
117 |
107 |
$5K |
| 92015 |
Determination of refractive state |
218 |
215 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
40 |
40 |
$0.00 |