| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,914 |
946 |
$64K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,367 |
1,344 |
$55K |
| V2020 |
Frames, purchases |
1,304 |
1,145 |
$46K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,424 |
618 |
$8K |
| V2750 |
Anti-reflective coating, per lens |
472 |
256 |
$6K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
90 |
90 |
$4K |
| V2760 |
Scratch resistant coating, per lens |
326 |
175 |
$2K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
75 |
51 |
$2K |
| V2523 |
Contact lens, hydrophilic, extended wear, per lens |
13 |
13 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
28 |
12 |
$748.72 |