| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
411 |
405 |
$27K |
| V2020 |
Frames, purchases |
441 |
433 |
$24K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
316 |
314 |
$4K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
29 |
29 |
$2K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
67 |
66 |
$1K |
| 92341 |
|
45 |
45 |
$900.00 |
| 92371 |
|
45 |
45 |
$301.00 |
| 92015 |
Determination of refractive state |
20 |
20 |
$0.00 |