| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
302 |
302 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
186 |
186 |
$796.16 |
| V2781 |
Progressive lens, per lens |
14 |
14 |
$165.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
210 |
210 |
$144.00 |
| V2299 |
Specialty bifocal (by report) |
14 |
14 |
$113.10 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
122 |
59 |
$65.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
97 |
44 |
$30.00 |
| V2744 |
Tint, photochromatic, per lens |
12 |
12 |
$0.00 |
| 92015 |
Determination of refractive state |
43 |
43 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
72 |
72 |
$0.00 |