| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
535 |
522 |
$36K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
242 |
241 |
$23K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
460 |
457 |
$15K |
| V2020 |
Frames, purchases |
613 |
527 |
$14K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
400 |
345 |
$6K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
616 |
521 |
$4K |
| 92015 |
Determination of refractive state |
635 |
633 |
$2K |
| V2760 |
Scratch resistant coating, per lens |
157 |
157 |
$314.02 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
16 |
14 |
$172.00 |
| S9999 |
Sales tax |
27 |
27 |
$41.91 |