| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
262 |
238 |
$15K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
259 |
183 |
$12K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
236 |
224 |
$11K |
| 92015 |
Determination of refractive state |
219 |
214 |
$4K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
13 |
12 |
$3K |
| V2025 |
Deluxe frame |
164 |
153 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
29 |
29 |
$1K |
| V2020 |
Frames, purchases |
121 |
111 |
$1K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
26 |
26 |
$782.34 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
25 |
24 |
$150.24 |