| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
651 |
607 |
$11K |
| V2020 |
Frames, purchases |
731 |
655 |
$9K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
355 |
333 |
$7K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
488 |
460 |
$3K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
125 |
110 |
$2K |
| 92015 |
Determination of refractive state |
97 |
87 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
67 |
58 |
$0.00 |