| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
236 |
134 |
$34K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
185 |
183 |
$23K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
172 |
169 |
$17K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
370 |
198 |
$14K |
| V2755 |
U-v lens, per lens |
372 |
198 |
$8K |
| V2750 |
Anti-reflective coating, per lens |
376 |
198 |
$8K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
215 |
167 |
$5K |
| 92250 |
|
126 |
125 |
$5K |
| V2025 |
Deluxe frame |
48 |
40 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
32 |
25 |
$2K |
| V2020 |
Frames, purchases |
42 |
38 |
$2K |