| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
731 |
619 |
$20K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
396 |
393 |
$17K |
| V2020 |
Frames, purchases |
897 |
879 |
$12K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
562 |
492 |
$11K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
745 |
661 |
$5K |
| 92015 |
Determination of refractive state |
787 |
784 |
$1K |
| S0500 |
Disposable contact lens, per lens |
14 |
13 |
$1K |
| V2025 |
Deluxe frame |
71 |
70 |
$930.24 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
152 |
152 |
$920.00 |
| V2760 |
Scratch resistant coating, per lens |
218 |
149 |
$738.91 |
| V2750 |
Anti-reflective coating, per lens |
237 |
237 |
$347.24 |