| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
294 |
277 |
$15K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
398 |
376 |
$12K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
256 |
252 |
$11K |
| V2020 |
Frames, purchases |
953 |
908 |
$7K |
| 92015 |
Determination of refractive state |
1,104 |
1,078 |
$6K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
12 |
12 |
$705.24 |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
12 |
12 |
$323.51 |