| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,507 |
733 |
$46K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
643 |
364 |
$12K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
235 |
231 |
$10K |
| V2783 |
Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens |
172 |
82 |
$8K |
| V2020 |
Frames, purchases |
918 |
876 |
$7K |
| 92015 |
Determination of refractive state |
1,056 |
1,031 |
$6K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
61 |
31 |
$915.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
13 |
13 |
$764.01 |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
13 |
13 |
$622.70 |
| 92002 |
|
13 |
13 |
$368.42 |