| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2782 |
Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens |
113 |
112 |
$4K |
| 92015 |
Determination of refractive state |
181 |
181 |
$4K |
| V2020 |
Frames, purchases |
115 |
114 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
55 |
55 |
$3K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
88 |
87 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
19 |
18 |
$382.20 |