| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
258 |
166 |
$14K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
134 |
90 |
$4K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
32 |
32 |
$3K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
39 |
38 |
$3K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
39 |
39 |
$2K |
| V2020 |
Frames, purchases |
237 |
152 |
$2K |
| 92250 |
|
21 |
21 |
$1K |
| 92015 |
Determination of refractive state |
144 |
141 |
$1K |
| 92060 |
|
12 |
12 |
$673.58 |