| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,468 |
1,407 |
$61K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
446 |
429 |
$30K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
399 |
389 |
$18K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
212 |
204 |
$9K |
| 92015 |
Determination of refractive state |
1,384 |
1,331 |
$8K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
87 |
81 |
$7K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
56 |
50 |
$1K |
| V2783 |
Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens |
16 |
12 |
$520.08 |