| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
390 |
274 |
$21K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
155 |
104 |
$5K |
| 92015 |
Determination of refractive state |
379 |
274 |
$3K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
30 |
30 |
$957.00 |
| V2020 |
Frames, purchases |
159 |
99 |
$760.24 |
| V2760 |
Scratch resistant coating, per lens |
33 |
33 |
$435.20 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
37 |
24 |
$152.82 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
12 |
12 |
$117.90 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$90.20 |