| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
616 |
307 |
$19K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
125 |
122 |
$5K |
| V2020 |
Frames, purchases |
376 |
355 |
$3K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
96 |
94 |
$3K |
| 92015 |
Determination of refractive state |
467 |
464 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
95 |
53 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
13 |
13 |
$764.01 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
49 |
25 |
$735.00 |