| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
821 |
817 |
$55K |
| V2020 |
Frames, purchases |
977 |
941 |
$30K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
309 |
303 |
$27K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
882 |
852 |
$23K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
906 |
693 |
$13K |
| V2783 |
Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens |
133 |
67 |
$6K |
| V2755 |
U-v lens, per lens |
764 |
412 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
941 |
507 |
$5K |
| V2750 |
Anti-reflective coating, per lens |
897 |
642 |
$5K |
| V2760 |
Scratch resistant coating, per lens |
1,506 |
835 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
44 |
36 |
$637.09 |
| 92015 |
Determination of refractive state |
1,331 |
1,327 |
$101.13 |