| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
120 |
105 |
$13K |
| V2020 |
Frames, purchases |
211 |
192 |
$11K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
135 |
119 |
$7K |
| 92015 |
Determination of refractive state |
385 |
379 |
$6K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
185 |
164 |
$4K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
40 |
40 |
$4K |
| V2750 |
Anti-reflective coating, per lens |
108 |
94 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
25 |
25 |
$2K |