| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
315 |
240 |
$10K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
89 |
87 |
$10K |
| 92250 |
|
95 |
95 |
$5K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
304 |
232 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
296 |
229 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
82 |
70 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
72 |
53 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
13 |
12 |
$1K |
| V2750 |
Anti-reflective coating, per lens |
13 |
12 |
$262.02 |
| 92015 |
Determination of refractive state |
148 |
146 |
$10.05 |