| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
353 |
345 |
$21K |
| 92015 |
Determination of refractive state |
733 |
722 |
$7K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
141 |
140 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
52 |
52 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
14 |
14 |
$995.29 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
27 |
27 |
$945.00 |
| V2756 |
Eye glass case |
598 |
580 |
$861.07 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
13 |
13 |
$604.80 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
12 |
12 |
$71.96 |
| V2025 |
Deluxe frame |
14 |
13 |
$0.00 |