| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2783 |
Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens |
58 |
27 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
34 |
34 |
$2K |
| 92015 |
Determination of refractive state |
46 |
46 |
$809.60 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
25 |
13 |
$437.50 |
| V2020 |
Frames, purchases |
33 |
33 |
$231.00 |