| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
378 |
365 |
$40K |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
47 |
44 |
$6K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
62 |
58 |
$2K |
| V2020 |
Frames, purchases |
51 |
48 |
$2K |
| V2750 |
Anti-reflective coating, per lens |
63 |
59 |
$2K |
| V2755 |
U-v lens, per lens |
49 |
46 |
$1K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
62 |
58 |
$1K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
13 |
12 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
14 |
14 |
$583.92 |