| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
125 |
124 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
123 |
122 |
$4K |
| V2020 |
Frames, purchases |
133 |
133 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
52 |
52 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
84 |
76 |
$1K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
18 |
18 |
$810.00 |