| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,181 |
1,181 |
$16K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,118 |
1,116 |
$15K |
| 92250 |
|
149 |
149 |
$7K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
86 |
86 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
136 |
134 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
73 |
73 |
$534.60 |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
39 |
39 |
$414.00 |
| 92341 |
|
12 |
12 |
$216.00 |