| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,786 |
1,785 |
$107K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,425 |
2,423 |
$104K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,433 |
1,432 |
$53K |
| V2020 |
Frames, purchases |
2,330 |
2,317 |
$49K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
842 |
842 |
$36K |
| 92015 |
Determination of refractive state |
3,368 |
3,368 |
$30K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
480 |
480 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
42 |
42 |
$1K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
13 |
13 |
$569.14 |