| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,729 |
853 |
$54K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
948 |
927 |
$41K |
| V2783 |
Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens |
343 |
152 |
$16K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
609 |
329 |
$11K |
| V2020 |
Frames, purchases |
1,176 |
1,076 |
$8K |
| 92015 |
Determination of refractive state |
1,329 |
1,292 |
$7K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
357 |
162 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
27 |
26 |
$2K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
27 |
26 |
$693.84 |