| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,637 |
1,417 |
$99K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,609 |
1,535 |
$68K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,380 |
1,329 |
$62K |
| V2020 |
Frames, purchases |
2,007 |
1,555 |
$60K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
217 |
214 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
3,310 |
1,251 |
$2K |
| 92015 |
Determination of refractive state |
236 |
233 |
$1K |