| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
3,089 |
2,244 |
$151K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,858 |
2,012 |
$82K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,609 |
1,578 |
$71K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
548 |
540 |
$29K |
| V2020 |
Frames, purchases |
2,828 |
2,263 |
$24K |
| 92015 |
Determination of refractive state |
2,017 |
1,986 |
$10K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
48 |
39 |
$2K |
| V2300 |
Sphere, trifocal, plano to plus or minus 4.00d, per lens |
15 |
12 |
$750.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
13 |
12 |
$288.50 |
| V2750 |
Anti-reflective coating, per lens |
26 |
12 |
$0.00 |
| V2745 |
Addition to lens; tint, any color, solid, gradient or equal, excludes photochromatic, any lens material, per lens |
13 |
12 |
$0.00 |