| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92250 |
|
372 |
337 |
$19K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
122 |
113 |
$15K |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
30 |
26 |
$2K |
| V2020 |
Frames, purchases |
31 |
27 |
$1K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
30 |
26 |
$503.53 |
| V2750 |
Anti-reflective coating, per lens |
29 |
26 |
$502.14 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
13 |
12 |
$477.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
31 |
27 |
$326.32 |
| 92015 |
Determination of refractive state |
374 |
342 |
$139.53 |