| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2783 |
Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens |
473 |
218 |
$20K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
255 |
255 |
$14K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
305 |
145 |
$9K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
425 |
219 |
$8K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
86 |
83 |
$5K |
| 92015 |
Determination of refractive state |
668 |
657 |
$5K |
| V2020 |
Frames, purchases |
513 |
473 |
$4K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
15 |
14 |
$411.74 |