| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
89 |
87 |
$2K |
| 92015 |
Determination of refractive state |
155 |
149 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
310 |
152 |
$971.42 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
59 |
30 |
$548.32 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
32 |
32 |
$321.80 |
| V2755 |
U-v lens, per lens |
206 |
100 |
$240.72 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
34 |
32 |
$91.46 |