| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
730 |
365 |
$15K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
292 |
291 |
$12K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
190 |
190 |
$8K |
| V2020 |
Frames, purchases |
634 |
627 |
$7K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
126 |
63 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
148 |
72 |
$3K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
45 |
42 |
$2K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
26 |
13 |
$534.04 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,312 |
649 |
$0.00 |