| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,163 |
1,131 |
$95K |
| V2020 |
Frames, purchases |
1,251 |
1,219 |
$87K |
| 92250 |
|
1,231 |
1,195 |
$73K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
705 |
692 |
$67K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
429 |
414 |
$26K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
211 |
207 |
$25K |
| 92015 |
Determination of refractive state |
1,383 |
1,345 |
$25K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
13 |
13 |
$826.80 |