| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
777 |
734 |
$41K |
| V2101 |
Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens |
227 |
218 |
$8K |
| V2020 |
Frames, purchases |
673 |
640 |
$5K |
| 92015 |
Determination of refractive state |
859 |
840 |
$4K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
93 |
92 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
28 |
28 |
$840.00 |
| V2201 |
Sphere, bifocal, plus or minus 4.12 to plus or minus 7.00d, per lens |
12 |
12 |
$540.00 |