| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
895 |
794 |
$24K |
| 92004 |
|
231 |
226 |
$17K |
| V2020 |
Frames, purchases |
1,060 |
934 |
$15K |
| 92014 |
|
233 |
215 |
$12K |
| 92015 |
|
1,237 |
1,153 |
$8K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
275 |
241 |
$4K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
97 |
94 |
$4K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
44 |
41 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
26 |
25 |
$495.36 |
| 92340 |
|
17 |
17 |
$22.48 |