| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
951 |
901 |
$20K |
| V2020 |
Frames, purchases |
1,151 |
1,080 |
$15K |
| 92015 |
Determination of refractive state |
1,006 |
966 |
$12K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
273 |
265 |
$12K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
273 |
258 |
$11K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
499 |
468 |
$4K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
76 |
70 |
$4K |
| 92310 |
|
19 |
19 |
$1K |
| 92250 |
|
12 |
12 |
$393.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
16 |
15 |
$304.78 |