| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
873 |
540 |
$52K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
425 |
414 |
$21K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
503 |
300 |
$16K |
| V2020 |
Frames, purchases |
835 |
515 |
$6K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
46 |
46 |
$3K |
| 92015 |
Determination of refractive state |
537 |
524 |
$2K |
| V2750 |
Anti-reflective coating, per lens |
48 |
31 |
$0.00 |