| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
1,158 |
1,101 |
$44K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
277 |
216 |
$17K |
| 92012 |
|
358 |
304 |
$16K |
| V2020 |
Frames, purchases |
269 |
268 |
$10K |
| 92015 |
|
694 |
692 |
$8K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
197 |
196 |
$3K |
| V2025 |
Deluxe frame |
176 |
112 |
$2K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
32 |
32 |
$1K |
| 92340 |
|
24 |
24 |
$702.72 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
13 |
13 |
$140.36 |
| V2760 |
Scratch resistant coating, per lens |
37 |
13 |
$0.00 |