| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
63 |
63 |
$6K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
35 |
35 |
$2K |
| V2020 |
Frames, purchases |
62 |
62 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
55 |
54 |
$2K |
| 92250 |
|
14 |
14 |
$607.92 |
| 92015 |
Determination of refractive state |
49 |
49 |
$465.06 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
49 |
49 |
$411.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
14 |
14 |
$361.40 |
| V2760 |
Scratch resistant coating, per lens |
48 |
48 |
$110.00 |