| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
245 |
242 |
$7K |
| V2020 |
Frames, purchases |
640 |
631 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
113 |
113 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
285 |
163 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
157 |
85 |
$1K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
13 |
12 |
$180.00 |
| V2755 |
U-v lens, per lens |
196 |
98 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
96 |
47 |
$0.00 |