| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
487 |
329 |
$13K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
251 |
149 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
196 |
117 |
$4K |
| V2020 |
Frames, purchases |
296 |
173 |
$4K |
| V2781 |
Progressive lens, per lens |
20 |
12 |
$1K |
| V2299 |
Specialty bifocal (by report) |
20 |
12 |
$716.30 |
| 92015 |
Determination of refractive state |
272 |
168 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
38 |
22 |
$0.00 |