| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
266 |
231 |
$16K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
264 |
244 |
$12K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
135 |
127 |
$5K |
| 92015 |
Determination of refractive state |
899 |
848 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
80 |
65 |
$62.95 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
183 |
176 |
$30.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
183 |
168 |
$17.18 |
| V2025 |
Deluxe frame |
22 |
18 |
$15.00 |
| V2755 |
U-v lens, per lens |
21 |
18 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
35 |
31 |
$0.00 |