| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
3,053 |
2,974 |
$82K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,311 |
2,234 |
$47K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
570 |
552 |
$11K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
100 |
98 |
$6K |
| 92015 |
Determination of refractive state |
726 |
722 |
$4K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
93 |
92 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
90 |
76 |
$801.19 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
12 |
12 |
$665.88 |