| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
154 |
136 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
62 |
62 |
$2K |
| V2020 |
Frames, purchases |
180 |
134 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
35 |
35 |
$1K |
| 92015 |
Determination of refractive state |
131 |
130 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
132 |
103 |
$980.00 |
| S0516 |
Safety eyeglass frames |
37 |
37 |
$591.26 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
156 |
125 |
$461.00 |
| S0504 |
Single vision prescription lens (safety, athletic, or sunglass), per lens |
37 |
37 |
$337.36 |
| 92341 |
|
15 |
12 |
$304.00 |
| S9999 |
Sales tax |
37 |
37 |
$50.70 |
| V2760 |
Scratch resistant coating, per lens |
16 |
16 |
$26.00 |