| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
883 |
518 |
$17K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
958 |
527 |
$11K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
372 |
206 |
$11K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
160 |
78 |
$2K |
| 92015 |
Determination of refractive state |
981 |
638 |
$1K |
| V2020 |
Frames, purchases |
881 |
524 |
$624.60 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,206 |
709 |
$357.96 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
156 |
65 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
34 |
14 |
$0.00 |
| V2025 |
Deluxe frame |
369 |
188 |
$0.00 |