| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
199 |
117 |
$9K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
199 |
146 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
159 |
104 |
$3K |
| V2020 |
Frames, purchases |
159 |
96 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
271 |
171 |
$140.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
15 |
15 |
$87.18 |
| V2025 |
Deluxe frame |
58 |
43 |
$0.00 |
| 92015 |
Determination of refractive state |
404 |
297 |
$0.00 |
| V2760 |
Scratch resistant coating, per lens |
233 |
143 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
166 |
101 |
$0.00 |