| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
211 |
204 |
$20K |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
41 |
39 |
$6K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
87 |
85 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
70 |
68 |
$5K |
| V2020 |
Frames, purchases |
78 |
75 |
$4K |
| V2750 |
Anti-reflective coating, per lens |
86 |
84 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
46 |
44 |
$975.60 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
13 |
13 |
$307.76 |
| 92015 |
Determination of refractive state |
231 |
222 |
$46.58 |
| V2799 |
Vision item or service, miscellaneous |
44 |
42 |
$0.00 |