| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
41 |
39 |
$1K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
43 |
41 |
$701.02 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
43 |
41 |
$588.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
15 |
15 |
$535.21 |
| V2750 |
Anti-reflective coating, per lens |
13 |
13 |
$282.96 |
| 92015 |
Determination of refractive state |
126 |
125 |
$0.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
29 |
29 |
$0.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
37 |
37 |
$0.00 |