| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
171 |
158 |
$15K |
| V2020 |
Frames, purchases |
865 |
715 |
$13K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
227 |
193 |
$3K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
30 |
29 |
$2K |
| 92015 |
Determination of refractive state |
696 |
609 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
381 |
299 |
$1K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
664 |
543 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
64 |
56 |
$194.36 |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
163 |
149 |
$122.18 |
| V2745 |
Addition to lens; tint, any color, solid, gradient or equal, excludes photochromatic, any lens material, per lens |
26 |
26 |
$0.00 |
| V2755 |
U-v lens, per lens |
26 |
26 |
$0.00 |