| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
104 |
102 |
$9K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
101 |
100 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
75 |
73 |
$3K |
| V2020 |
Frames, purchases |
90 |
89 |
$2K |
| 92015 |
Determination of refractive state |
194 |
193 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
15 |
15 |
$650.70 |