| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
128 |
119 |
$5K |
| V2020 |
Frames, purchases |
205 |
194 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
151 |
142 |
$4K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
78 |
73 |
$4K |
| 92015 |
Determination of refractive state |
306 |
291 |
$935.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
28 |
23 |
$891.50 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
13 |
12 |
$814.00 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
18 |
15 |
$567.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
236 |
218 |
$224.50 |
| 92310 |
|
12 |
12 |
$35.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
46 |
42 |
$5.00 |
| 92341 |
|
13 |
13 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
20 |
18 |
$0.00 |
| V2025 |
Deluxe frame |
18 |
14 |
$0.00 |