| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,773 |
2,773 |
$225K |
| V2020 |
Frames, purchases |
3,643 |
3,640 |
$114K |
| 92015 |
Determination of refractive state |
7,097 |
7,081 |
$109K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,496 |
2,496 |
$109K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
1,214 |
1,214 |
$47K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
5,706 |
5,406 |
$35K |
| 92250 |
|
3,026 |
2,833 |
$28K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,686 |
1,581 |
$18K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
3,103 |
3,034 |
$16K |
| V2755 |
U-v lens, per lens |
351 |
351 |
$11K |
| V2204 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
165 |
165 |
$6K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
43 |
43 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
53 |
53 |
$1K |
| 67820 |
|
92 |
81 |
$728.05 |
| V2201 |
Sphere, bifocal, plus or minus 4.12 to plus or minus 7.00d, per lens |
12 |
12 |
$404.25 |
| 92020 |
|
15 |
13 |
$10.82 |