| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,007 |
939 |
$56K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
599 |
506 |
$22K |
| V2020 |
Frames, purchases |
122 |
111 |
$6K |
| V2025 |
Deluxe frame |
324 |
272 |
$6K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
239 |
231 |
$1K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
27 |
27 |
$1K |
| 92015 |
Determination of refractive state |
246 |
224 |
$817.18 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
32 |
26 |
$15.00 |
| V2750 |
Anti-reflective coating, per lens |
65 |
51 |
$0.00 |
| 2026F |
|
43 |
43 |
$0.00 |