| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,265 |
1,189 |
$118K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
602 |
567 |
$62K |
| V2020 |
Frames, purchases |
1,319 |
1,270 |
$53K |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
642 |
632 |
$53K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,407 |
1,360 |
$35K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
657 |
634 |
$28K |
| V2750 |
Anti-reflective coating, per lens |
1,111 |
1,071 |
$28K |
| V2781 |
Progressive lens, per lens |
292 |
277 |
$26K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,555 |
1,492 |
$26K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
39 |
39 |
$2K |
| V2744 |
Tint, photochromatic, per lens |
101 |
97 |
$2K |
| 92015 |
Determination of refractive state |
2,491 |
2,316 |
$1K |
| V2025 |
Deluxe frame |
12 |
12 |
$815.54 |