| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92250 |
|
538 |
535 |
$28K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
423 |
323 |
$25K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
271 |
271 |
$13K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
128 |
98 |
$4K |
| 92015 |
Determination of refractive state |
555 |
552 |
$3K |
| V2020 |
Frames, purchases |
371 |
279 |
$3K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
12 |
12 |
$705.24 |