| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
68 |
64 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
41 |
40 |
$4K |
| 92015 |
Determination of refractive state |
278 |
260 |
$4K |
| V2020 |
Frames, purchases |
95 |
90 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
75 |
42 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
59 |
56 |
$1K |
| 99072 |
|
26 |
25 |
$250.25 |