| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
377 |
364 |
$31K |
| V2020 |
Frames, purchases |
721 |
644 |
$10K |
| 92004 |
|
89 |
86 |
$8K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
368 |
316 |
$7K |
| 92015 |
|
587 |
567 |
$5K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
76 |
74 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
371 |
208 |
$4K |
| 99212 |
|
25 |
25 |
$483.64 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
39 |
26 |
$385.00 |
| 92133 |
|
12 |
12 |
$379.25 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
12 |
12 |
$39.00 |