| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2750 |
Anti-reflective coating, per lens |
636 |
485 |
$55K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
638 |
485 |
$10K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
630 |
478 |
$8K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
502 |
369 |
$6K |
| V2020 |
Frames, purchases |
639 |
484 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
18 |
13 |
$840.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$240.00 |
| 92015 |
Determination of refractive state |
35 |
25 |
$180.00 |