| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
915 |
736 |
$21K |
| V2020 |
Frames, purchases |
1,120 |
901 |
$16K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
562 |
458 |
$15K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
586 |
448 |
$14K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
730 |
576 |
$13K |
| V2750 |
Anti-reflective coating, per lens |
364 |
283 |
$0.00 |
| 92015 |
Determination of refractive state |
331 |
282 |
$0.00 |