| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
473 |
467 |
$20K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
704 |
695 |
$17K |
| V2020 |
Frames, purchases |
807 |
798 |
$15K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
313 |
310 |
$13K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
637 |
630 |
$6K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
15 |
15 |
$527.80 |
| V2744 |
Tint, photochromatic, per lens |
29 |
29 |
$0.00 |
| 92015 |
Determination of refractive state |
818 |
809 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
16 |
16 |
$0.00 |