| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
865 |
522 |
$50K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
635 |
625 |
$20K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
234 |
145 |
$8K |
| V2020 |
Frames, purchases |
884 |
551 |
$7K |
| 92015 |
Determination of refractive state |
771 |
760 |
$2K |
| V2101 |
Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens |
23 |
16 |
$794.88 |
| 92002 |
|
13 |
13 |
$568.34 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
19 |
12 |
$541.60 |