| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
140 |
140 |
$3K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
42 |
42 |
$2K |
| 92015 |
Determination of refractive state |
219 |
219 |
$2K |
| V2020 |
Frames, purchases |
124 |
124 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
153 |
153 |
$306.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
21 |
12 |
$147.00 |
| V2760 |
Scratch resistant coating, per lens |
24 |
24 |
$120.00 |