| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
543 |
514 |
$16K |
| V2020 |
Frames, purchases |
1,349 |
935 |
$14K |
| 92004 |
|
172 |
166 |
$6K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
353 |
277 |
$5K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
342 |
241 |
$3K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
103 |
88 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
354 |
193 |
$1K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
86 |
61 |
$899.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
14 |
14 |
$650.00 |
| 92340 |
|
14 |
14 |
$390.32 |
| 92015 |
|
629 |
580 |
$0.00 |