| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
108 |
107 |
$4K |
| V2750 |
Anti-reflective coating, per lens |
111 |
110 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
70 |
69 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
104 |
103 |
$2K |
| V2781 |
Progressive lens, per lens |
18 |
18 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
108 |
107 |
$1K |
| V2744 |
Tint, photochromatic, per lens |
76 |
76 |
$721.74 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
13 |
13 |
$527.22 |
| 92015 |
Determination of refractive state |
307 |
298 |
$36.34 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
94 |
94 |
$0.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
173 |
170 |
$0.00 |