| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
568 |
464 |
$41K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
523 |
426 |
$28K |
| V2025 |
Deluxe frame |
554 |
463 |
$28K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
585 |
466 |
$16K |
| 92250 |
|
545 |
426 |
$15K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
361 |
257 |
$12K |
| V2750 |
Anti-reflective coating, per lens |
587 |
467 |
$12K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
144 |
118 |
$11K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
584 |
460 |
$9K |
| 92015 |
Determination of refractive state |
618 |
449 |
$109.41 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
14 |
14 |
$0.00 |
| V2020 |
Frames, purchases |
20 |
19 |
$0.00 |