| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
87 |
85 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
26 |
26 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
15 |
15 |
$1K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
66 |
65 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
12 |
12 |
$323.40 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
27 |
27 |
$200.00 |
| V2760 |
Scratch resistant coating, per lens |
32 |
32 |
$61.25 |
| 92015 |
Determination of refractive state |
213 |
207 |
$20.22 |