| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
252 |
242 |
$17K |
| V2020 |
Frames, purchases |
263 |
243 |
$7K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
178 |
165 |
$5K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
134 |
120 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
12 |
12 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
160 |
135 |
$1K |
| 92015 |
Determination of refractive state |
366 |
356 |
$444.84 |
| V2760 |
Scratch resistant coating, per lens |
154 |
130 |
$263.50 |