| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
109 |
106 |
$13K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
98 |
52 |
$9K |
| V2020 |
Frames, purchases |
116 |
65 |
$7K |
| 92250 |
|
167 |
161 |
$7K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
57 |
56 |
$5K |
| V2750 |
Anti-reflective coating, per lens |
76 |
41 |
$3K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
98 |
52 |
$3K |
| 92015 |
Determination of refractive state |
374 |
359 |
$287.92 |