| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
197 |
126 |
$14K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
79 |
75 |
$9K |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
48 |
40 |
$7K |
| V2750 |
Anti-reflective coating, per lens |
248 |
169 |
$5K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
247 |
169 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
224 |
156 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
115 |
80 |
$4K |
| 92015 |
Determination of refractive state |
182 |
164 |
$35.16 |