| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
751 |
593 |
$21K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
358 |
338 |
$13K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
494 |
395 |
$12K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
789 |
614 |
$8K |
| 92015 |
Determination of refractive state |
588 |
540 |
$6K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
107 |
89 |
$4K |
| 3072F |
|
448 |
294 |
$2K |
| V2730 |
Special base curve, glass or plastic, per lens |
56 |
32 |
$325.50 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
14 |
12 |
$191.72 |
| V2760 |
Scratch resistant coating, per lens |
352 |
235 |
$0.00 |
| V2755 |
U-v lens, per lens |
352 |
235 |
$0.00 |