| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
158 |
101 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
18 |
18 |
$1K |
| 92015 |
Determination of refractive state |
164 |
159 |
$403.70 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
128 |
80 |
$83.24 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
36 |
34 |
$50.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
114 |
63 |
$19.00 |
| V2750 |
Anti-reflective coating, per lens |
13 |
13 |
$0.00 |