| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
4,051 |
1,976 |
$124K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,011 |
1,099 |
$36K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
652 |
644 |
$19K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
287 |
285 |
$16K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
372 |
372 |
$16K |
| V2020 |
Frames, purchases |
2,043 |
1,938 |
$14K |
| 92015 |
Determination of refractive state |
2,038 |
2,019 |
$9K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
514 |
254 |
$8K |
| 92002 |
|
273 |
270 |
$8K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
117 |
64 |
$2K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
24 |
12 |
$480.00 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
24 |
13 |
$480.00 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
18 |
12 |
$315.00 |