| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
303 |
302 |
$31K |
| V2020 |
Frames, purchases |
981 |
929 |
$29K |
| 92004 |
|
214 |
214 |
$26K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
343 |
343 |
$25K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
977 |
936 |
$22K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
681 |
650 |
$18K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
259 |
258 |
$18K |
| 92015 |
|
667 |
666 |
$10K |
| V2025 |
Deluxe frame |
204 |
202 |
$9K |
| V2750 |
Anti-reflective coating, per lens |
419 |
412 |
$5K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
172 |
168 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
75 |
69 |
$2K |