| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
241 |
238 |
$29K |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
64 |
61 |
$8K |
| V2020 |
Frames, purchases |
63 |
60 |
$2K |
| V2755 |
U-v lens, per lens |
62 |
59 |
$2K |
| V2750 |
Anti-reflective coating, per lens |
64 |
61 |
$1K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
65 |
61 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
64 |
61 |
$735.28 |
| 92015 |
Determination of refractive state |
256 |
251 |
$256.78 |