| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2750 |
Anti-reflective coating, per lens |
556 |
480 |
$33K |
| V2755 |
U-v lens, per lens |
495 |
416 |
$30K |
| 92341 |
|
775 |
678 |
$13K |
| V2499 |
Variable sphericity lens, other type |
140 |
113 |
$9K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
101 |
100 |
$8K |
| 92015 |
Determination of refractive state |
760 |
719 |
$6K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
380 |
327 |
$6K |
| V2020 |
Frames, purchases |
700 |
604 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
40 |
38 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
44 |
42 |
$722.40 |
| V2760 |
Scratch resistant coating, per lens |
163 |
135 |
$0.00 |