| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
371 |
371 |
$9K |
| V2020 |
Frames, purchases |
431 |
431 |
$7K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
101 |
101 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
93 |
93 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
385 |
385 |
$3K |
| 92015 |
Determination of refractive state |
199 |
199 |
$0.00 |