| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
917 |
584 |
$30K |
| V2020 |
Frames, purchases |
860 |
847 |
$24K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
395 |
387 |
$16K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
165 |
164 |
$7K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
34 |
33 |
$1K |
| V2750 |
Anti-reflective coating, per lens |
46 |
25 |
$693.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
206 |
112 |
$656.22 |