| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
592 |
586 |
$24K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
340 |
122 |
$9K |
| V2020 |
Frames, purchases |
192 |
139 |
$6K |
| V2750 |
Anti-reflective coating, per lens |
96 |
36 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
13 |
13 |
$545.40 |
| V2760 |
Scratch resistant coating, per lens |
40 |
12 |
$400.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
234 |
78 |
$95.00 |
| 92015 |
Determination of refractive state |
73 |
73 |
$17.60 |