| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
960 |
886 |
$21K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
133 |
133 |
$14K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
508 |
230 |
$13K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
57 |
57 |
$4K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
168 |
168 |
$1K |
| V2744 |
Tint, photochromatic, per lens |
206 |
100 |
$872.04 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
30 |
13 |
$789.88 |
| 92015 |
Determination of refractive state |
100 |
100 |
$519.77 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
36 |
18 |
$493.98 |