| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
80 |
37 |
$600.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
101 |
45 |
$522.48 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
40 |
17 |
$440.00 |
| V2020 |
Frames, purchases |
127 |
58 |
$385.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
53 |
24 |
$230.00 |
| 92015 |
Determination of refractive state |
42 |
24 |
$0.00 |