| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
354 |
344 |
$6K |
| V2020 |
Frames, purchases |
517 |
503 |
$6K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
511 |
494 |
$3K |
| 92015 |
Determination of refractive state |
43 |
43 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
25 |
25 |
$1K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
40 |
40 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
29 |
28 |
$550.00 |