| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
127 |
127 |
$7K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
83 |
83 |
$6K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
51 |
51 |
$6K |
| V2020 |
Frames, purchases |
131 |
131 |
$5K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
80 |
80 |
$4K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
125 |
125 |
$2K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
28 |
28 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
22 |
22 |
$915.05 |