| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
774 |
774 |
$27K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
117 |
117 |
$6K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
132 |
93 |
$4K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
71 |
53 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
76 |
76 |
$4K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
61 |
61 |
$3K |
| 92341 |
|
93 |
93 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
61 |
59 |
$932.16 |
| 92002 |
|
13 |
13 |
$606.78 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
27 |
27 |
$405.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
64 |
38 |
$200.00 |
| V2745 |
Addition to lens; tint, any color, solid, gradient or equal, excludes photochromatic, any lens material, per lens |
240 |
137 |
$0.00 |