| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
589 |
589 |
$15K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
242 |
241 |
$14K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
211 |
211 |
$12K |
| 92015 |
Determination of refractive state |
594 |
594 |
$2K |
| 92341 |
|
32 |
32 |
$989.64 |
| V2020 |
Frames, purchases |
14 |
14 |
$130.00 |
| V2760 |
Scratch resistant coating, per lens |
13 |
13 |
$130.00 |
| 92250 |
|
14 |
14 |
$112.98 |
| V2755 |
U-v lens, per lens |
13 |
13 |
$78.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
13 |
13 |
$52.00 |