| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
328 |
325 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
77 |
77 |
$1K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
51 |
51 |
$600.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
12 |
12 |
$60.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
150 |
75 |
$0.00 |
| V2755 |
U-v lens, per lens |
328 |
163 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
236 |
116 |
$0.00 |