| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,020 |
474 |
$25K |
| V2020 |
Frames, purchases |
631 |
501 |
$17K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
142 |
140 |
$6K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
85 |
85 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
531 |
231 |
$3K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
25 |
25 |
$570.00 |
| 92015 |
Determination of refractive state |
13 |
13 |
$58.40 |