| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
297 |
284 |
$9K |
| V2025 |
Deluxe frame |
204 |
203 |
$9K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
171 |
162 |
$8K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
282 |
281 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
158 |
141 |
$4K |
| 92015 |
Determination of refractive state |
97 |
96 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
26 |
26 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
65 |
62 |
$60.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
98 |
97 |
$52.50 |