| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
2,260 |
2,160 |
$200K |
| 92004 |
|
1,615 |
1,572 |
$177K |
| V2020 |
Frames, purchases |
5,089 |
4,810 |
$83K |
| 92015 |
|
4,396 |
4,242 |
$65K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
3,567 |
3,366 |
$42K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,894 |
1,754 |
$36K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,555 |
1,509 |
$33K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
319 |
317 |
$14K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
290 |
288 |
$12K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
47 |
44 |
$834.12 |