| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
347 |
343 |
$6K |
| V2020 |
Frames, purchases |
373 |
368 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
164 |
162 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
93 |
92 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
359 |
354 |
$2K |
| 92015 |
Determination of refractive state |
366 |
363 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
62 |
60 |
$0.00 |