| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2750 |
Anti-reflective coating, per lens |
809 |
808 |
$36K |
| V2020 |
Frames, purchases |
1,590 |
1,564 |
$26K |
| 92250 |
|
402 |
380 |
$21K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
770 |
768 |
$21K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
255 |
236 |
$21K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
534 |
532 |
$19K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
106 |
100 |
$11K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
182 |
168 |
$10K |
| 92015 |
Determination of refractive state |
708 |
675 |
$6K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
26 |
26 |
$720.34 |
| V2204 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
17 |
17 |
$523.06 |
| 76514 |
|
12 |
12 |
$92.76 |