| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,342 |
1,333 |
$18K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
268 |
265 |
$6K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
452 |
452 |
$6K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
130 |
130 |
$6K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
173 |
173 |
$1K |
| 92015 |
Determination of refractive state |
74 |
74 |
$828.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
12 |
12 |
$519.36 |
| 92370 |
|
78 |
77 |
$384.30 |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
12 |
12 |
$216.00 |