| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
207 |
207 |
$4K |
| V2521 |
Contact lens, hydrophilic, toric, or prism ballast, per lens |
36 |
36 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
636 |
348 |
$1K |
| V2020 |
Frames, purchases |
163 |
163 |
$720.00 |
| V2500 |
Contact lens, pmma, spherical, per lens |
756 |
746 |
$100.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
446 |
241 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
37 |
19 |
$0.00 |