| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
128 |
128 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
112 |
112 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
25 |
25 |
$1K |
| V2020 |
Frames, purchases |
115 |
115 |
$1K |
| 92015 |
Determination of refractive state |
114 |
114 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
115 |
115 |
$460.00 |
| V2760 |
Scratch resistant coating, per lens |
31 |
31 |
$310.00 |