| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
440 |
440 |
$8K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
372 |
194 |
$8K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
142 |
139 |
$6K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
96 |
96 |
$4K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
26 |
25 |
$375.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
585 |
293 |
$0.00 |