| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
174 |
171 |
$10K |
| V2020 |
Frames, purchases |
508 |
293 |
$10K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
465 |
264 |
$352.98 |
| 92015 |
Determination of refractive state |
281 |
277 |
$15.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
467 |
266 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
12 |
12 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
12 |
12 |
$0.00 |