| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
468 |
300 |
$32K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
227 |
208 |
$6K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
74 |
70 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
224 |
132 |
$379.70 |
| 3072F |
|
527 |
403 |
$364.36 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
492 |
300 |
$270.00 |
| 92015 |
Determination of refractive state |
387 |
358 |
$75.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
25 |
14 |
$27.18 |
| V2760 |
Scratch resistant coating, per lens |
364 |
236 |
$0.00 |
| V2755 |
U-v lens, per lens |
367 |
238 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
37 |
29 |
$0.00 |