| 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 |
677 |
672 |
$24K |
| V2020 |
Frames, purchases |
737 |
731 |
$23K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
648 |
643 |
$17K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
165 |
163 |
$10K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
360 |
359 |
$7K |
| 92015 |
Determination of refractive state |
163 |
162 |
$4K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
31 |
31 |
$429.30 |