| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
762 |
403 |
$16K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
752 |
392 |
$8K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
77 |
75 |
$5K |
| V2430 |
Variable asphericity lens, bifocal, full field, glass or plastic, per lens |
12 |
12 |
$1K |
| 92341 |
|
55 |
55 |
$790.73 |
| 92342 |
|
12 |
12 |
$360.00 |
| 92015 |
Determination of refractive state |
14 |
13 |
$183.21 |
| V2755 |
U-v lens, per lens |
380 |
113 |
$145.68 |
| V2220 |
Bifocal add over 3.25d |
12 |
12 |
$66.66 |
| V2745 |
Addition to lens; tint, any color, solid, gradient or equal, excludes photochromatic, any lens material, per lens |
13 |
13 |
$39.52 |
| V2205 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
349 |
263 |
$36.00 |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
69 |
14 |
$0.00 |
| V2102 |
Sphere, single vision, plus or minus 7.12 to plus or minus 20.00d, per lens |
218 |
138 |
$0.00 |
| V2300 |
Sphere, trifocal, plano to plus or minus 4.00d, per lens |
242 |
54 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
121 |
116 |
$0.00 |
| V2715 |
Prism, per lens |
133 |
47 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
54 |
24 |
$0.00 |
| V2782 |
Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens |
284 |
65 |
$0.00 |