| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
40 |
39 |
$299.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
29 |
28 |
$213.38 |
| 92134 |
|
44 |
43 |
$64.34 |
| 92015 |
Determination of refractive state |
44 |
43 |
$33.32 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
15 |
15 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
39 |
38 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
24 |
24 |
$0.00 |
| V2521 |
Contact lens, hydrophilic, toric, or prism ballast, per lens |
15 |
15 |
$0.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
36 |
35 |
$0.00 |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
23 |
22 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
38 |
37 |
$0.00 |