| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
|
1,198 |
1,092 |
$79K |
| 92014 |
|
342 |
327 |
$24K |
| 92015 |
|
1,956 |
1,807 |
$20K |
| V2020 |
Frames, purchases |
495 |
488 |
$16K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
301 |
297 |
$12K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
217 |
214 |
$4K |
| 92340 |
|
101 |
99 |
$2K |
| 92250 |
|
241 |
216 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$365.70 |
| S9986 |
Not medically necessary service (patient is aware that service not medically necessary) |
12 |
12 |
$0.00 |