| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
618 |
556 |
$31K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
227 |
219 |
$21K |
| V2020 |
Frames, purchases |
708 |
631 |
$16K |
| 92015 |
Determination of refractive state |
667 |
627 |
$11K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
117 |
93 |
$7K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
68 |
55 |
$2K |