| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
194 |
193 |
$6K |
| V2020 |
Frames, purchases |
196 |
195 |
$5K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
84 |
83 |
$3K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
69 |
68 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
137 |
136 |
$839.79 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$677.50 |
| 92015 |
Determination of refractive state |
185 |
182 |
$0.00 |