| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
443 |
330 |
$8K |
| V2020 |
Frames, purchases |
396 |
350 |
$7K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
103 |
92 |
$5K |
| 92015 |
Determination of refractive state |
384 |
321 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
139 |
104 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
29 |
29 |
$638.00 |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
20 |
12 |
$374.76 |