| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
186 |
164 |
$11K |
| V2020 |
Frames, purchases |
171 |
153 |
$5K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
165 |
151 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
43 |
42 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
38 |
26 |
$475.01 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
45 |
44 |
$352.51 |
| V2760 |
Scratch resistant coating, per lens |
15 |
15 |
$30.13 |
| 92015 |
Determination of refractive state |
498 |
460 |
$0.00 |