| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
815 |
808 |
$16K |
| V2020 |
Frames, purchases |
815 |
812 |
$8K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
361 |
358 |
$5K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
86 |
85 |
$4K |
| 92015 |
Determination of refractive state |
396 |
393 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
811 |
808 |
$3K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
56 |
56 |
$3K |
| V2760 |
Scratch resistant coating, per lens |
138 |
138 |
$1K |
| 3072F |
|
80 |
80 |
$800.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
25 |
25 |
$460.50 |
| V2101 |
Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens |
19 |
19 |
$266.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
12 |
12 |
$168.00 |