| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
231 |
231 |
$9K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
145 |
145 |
$8K |
| V2020 |
Frames, purchases |
226 |
226 |
$7K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
101 |
101 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
66 |
66 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
26 |
26 |
$1K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
14 |
14 |
$528.36 |
| V2760 |
Scratch resistant coating, per lens |
116 |
116 |
$516.58 |
| V2755 |
U-v lens, per lens |
115 |
115 |
$381.74 |
| 92341 |
|
13 |
13 |
$350.61 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
13 |
13 |
$275.08 |
| 92015 |
Determination of refractive state |
238 |
238 |
$160.56 |
| 2023F |
|
136 |
136 |
$0.00 |