| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
|
1,287 |
1,275 |
$48K |
| V2020 |
Frames, purchases |
1,714 |
1,696 |
$22K |
| 92250 |
|
358 |
356 |
$16K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
774 |
633 |
$13K |
| 92014 |
|
105 |
104 |
$5K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
176 |
148 |
$4K |
| 92286 |
|
68 |
68 |
$4K |
| 92285 |
|
89 |
86 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
192 |
131 |
$2K |
| 68801 |
|
15 |
15 |
$1K |
| 92015 |
|
197 |
197 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
172 |
132 |
$969.00 |
| 76512 |
|
14 |
14 |
$619.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
15 |
15 |
$400.00 |
| 92341 |
|
13 |
13 |
$260.00 |
| 92340 |
|
14 |
13 |
$90.00 |
| 68040 |
|
55 |
55 |
$0.00 |
| 92025 |
|
43 |
43 |
$0.00 |
| V2756 |
Eye glass case |
71 |
71 |
$0.00 |