| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
622 |
615 |
$15K |
| V2020 |
Frames, purchases |
881 |
865 |
$15K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
82 |
80 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
29 |
28 |
$861.08 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
119 |
114 |
$724.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
26 |
25 |
$672.41 |
| 92015 |
Determination of refractive state |
63 |
61 |
$0.00 |