| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
397 |
390 |
$12K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
183 |
181 |
$9K |
| V2020 |
Frames, purchases |
376 |
373 |
$8K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
199 |
196 |
$4K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
67 |
67 |
$3K |
| 92015 |
Determination of refractive state |
447 |
445 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
49 |
48 |
$839.16 |