| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
53 |
46 |
$3K |
| V2020 |
Frames, purchases |
91 |
87 |
$3K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
94 |
89 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
102 |
97 |
$628.51 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
26 |
26 |
$430.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
15 |
13 |
$369.00 |
| V2760 |
Scratch resistant coating, per lens |
43 |
39 |
$62.00 |