| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
65 |
65 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
44 |
44 |
$1K |
| V2020 |
Frames, purchases |
48 |
47 |
$1K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
66 |
66 |
$975.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
32 |
31 |
$864.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
15 |
15 |
$441.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
40 |
36 |
$90.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
20 |
20 |
$0.00 |