| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
728 |
726 |
$35K |
| V2020 |
Frames, purchases |
963 |
910 |
$26K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
568 |
541 |
$23K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,390 |
1,373 |
$21K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
659 |
612 |
$19K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
106 |
104 |
$5K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
704 |
652 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
584 |
580 |
$164.50 |
| V2750 |
Anti-reflective coating, per lens |
13 |
12 |
$0.00 |