| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,411 |
1,359 |
$162K |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
102 |
82 |
$18K |
| V2025 |
Deluxe frame |
103 |
78 |
$10K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
121 |
97 |
$6K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
35 |
35 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
75 |
50 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
50 |
49 |
$3K |
| V2750 |
Anti-reflective coating, per lens |
109 |
90 |
$3K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
126 |
102 |
$3K |
| V2755 |
U-v lens, per lens |
66 |
65 |
$2K |
| V2020 |
Frames, purchases |
15 |
15 |
$1K |
| 92015 |
Determination of refractive state |
430 |
419 |
$270.40 |