| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2783 |
Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens |
72 |
72 |
$22K |
| V2020 |
Frames, purchases |
777 |
777 |
$16K |
| 92002 |
|
359 |
358 |
$13K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
501 |
501 |
$7K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
334 |
334 |
$3K |
| 92015 |
Determination of refractive state |
192 |
192 |
$2K |
| 92341 |
|
74 |
74 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
83 |
83 |
$594.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
31 |
31 |
$538.20 |