| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
344 |
334 |
$31K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
117 |
113 |
$8K |
| V2020 |
Frames, purchases |
194 |
192 |
$6K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
176 |
174 |
$4K |
| 92015 |
Determination of refractive state |
731 |
708 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
130 |
129 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
109 |
108 |
$913.27 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
46 |
46 |
$788.72 |
| V2760 |
Scratch resistant coating, per lens |
86 |
86 |
$130.00 |