| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
317 |
300 |
$13K |
| V2760 |
Scratch resistant coating, per lens |
279 |
267 |
$6K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
109 |
104 |
$6K |
| 92015 |
Determination of refractive state |
1,018 |
966 |
$5K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
91 |
86 |
$4K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
12 |
12 |
$1K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
13 |
12 |
$817.68 |