| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92012 |
|
671 |
667 |
$47K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,464 |
1,450 |
$36K |
| V2025 |
Deluxe frame |
785 |
784 |
$30K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,393 |
1,380 |
$27K |
| V2020 |
Frames, purchases |
1,524 |
1,488 |
$25K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
587 |
586 |
$25K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
293 |
293 |
$13K |
| 92015 |
|
951 |
949 |
$12K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
552 |
540 |
$9K |
| 92002 |
|
71 |
70 |
$5K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
44 |
43 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
28 |
28 |
$409.86 |