| Code | Description | Claims | Beneficiaries | Total Paid |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
273 |
260 |
$13K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
118 |
115 |
$11K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
94 |
93 |
$6K |
| V2020 |
Frames, purchases |
155 |
148 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
80 |
50 |
$800.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
52 |
52 |
$408.00 |
| 92015 |
Determination of refractive state |
427 |
402 |
$155.00 |
| V2760 |
Scratch resistant coating, per lens |
52 |
52 |
$103.00 |