| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
165 |
150 |
$2K |
| V2020 |
Frames, purchases |
206 |
186 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
87 |
79 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
69 |
62 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
69 |
60 |
$520.00 |
| 92015 |
Determination of refractive state |
110 |
97 |
$0.00 |