| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
3,580 |
2,178 |
$207K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,529 |
1,465 |
$66K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,811 |
1,094 |
$57K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
646 |
627 |
$37K |
| V2020 |
Frames, purchases |
3,268 |
2,043 |
$22K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
436 |
269 |
$13K |
| 92250 |
|
192 |
186 |
$10K |
| 92015 |
Determination of refractive state |
2,135 |
2,058 |
$9K |
| V2303 |
Spherocylinder, trifocal, plano to plus or minus 4.00d sphere, .12-2.00d cylinder, per lens |
22 |
15 |
$880.00 |
| V2750 |
Anti-reflective coating, per lens |
56 |
27 |
$22.00 |
| V2025 |
Deluxe frame |
51 |
36 |
$0.00 |
| V2781 |
Progressive lens, per lens |
43 |
28 |
$0.00 |