| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
449 |
418 |
$17K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
183 |
168 |
$15K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
192 |
178 |
$5K |
| V2760 |
Scratch resistant coating, per lens |
409 |
382 |
$5K |
| 92015 |
Determination of refractive state |
348 |
319 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
18 |
17 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
16 |
16 |
$780.89 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
14 |
13 |
$187.59 |
| V2755 |
U-v lens, per lens |
95 |
85 |
$140.00 |