| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,829 |
1,151 |
$101K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
984 |
963 |
$44K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
528 |
315 |
$19K |
| V2020 |
Frames, purchases |
1,902 |
1,225 |
$17K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
385 |
271 |
$11K |
| 92015 |
Determination of refractive state |
1,390 |
1,358 |
$7K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
14 |
13 |
$764.01 |