| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2115 |
Lenticular, (myodisc), per lens, single vision |
100 |
70 |
$9K |
| V2020 |
Frames, purchases |
311 |
239 |
$5K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
106 |
56 |
$4K |
| 92002 |
|
89 |
76 |
$4K |
| V2025 |
Deluxe frame |
30 |
30 |
$1K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
19 |
19 |
$751.35 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
14 |
13 |
$566.35 |
| 92015 |
Determination of refractive state |
88 |
87 |
$525.00 |
| V2799 |
Vision item or service, miscellaneous |
54 |
52 |
$340.00 |