| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
285 |
258 |
$17K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
224 |
211 |
$15K |
| V2020 |
Frames, purchases |
177 |
170 |
$2K |
| 92015 |
Determination of refractive state |
385 |
378 |
$1K |
| V2025 |
Deluxe frame |
92 |
92 |
$954.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
391 |
363 |
$836.87 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
170 |
164 |
$240.97 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
165 |
160 |
$4.00 |
| V2750 |
Anti-reflective coating, per lens |
47 |
47 |
$0.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$0.00 |
| 92341 |
|
12 |
12 |
$0.00 |