| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92015 |
Determination of refractive state |
507 |
505 |
$15K |
| 92002 |
|
353 |
352 |
$11K |
| V2303 |
Spherocylinder, trifocal, plano to plus or minus 4.00d sphere, .12-2.00d cylinder, per lens |
12 |
12 |
$750.78 |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
13 |
12 |
$378.00 |
| V2760 |
Scratch resistant coating, per lens |
82 |
82 |
$0.00 |
| V2020 |
Frames, purchases |
87 |
87 |
$0.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
12 |
12 |
$0.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
48 |
48 |
$0.00 |
| V2702 |
Deluxe lens feature |
67 |
67 |
$0.00 |
| V2755 |
U-v lens, per lens |
85 |
85 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
57 |
57 |
$0.00 |
| V2781 |
Progressive lens, per lens |
32 |
32 |
$0.00 |
| V2744 |
Tint, photochromatic, per lens |
44 |
44 |
$0.00 |