| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
339 |
327 |
$17K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
147 |
144 |
$8K |
| V2760 |
Scratch resistant coating, per lens |
297 |
288 |
$7K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
73 |
73 |
$7K |
| 92015 |
Determination of refractive state |
333 |
325 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
13 |
12 |
$891.12 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
15 |
13 |
$785.00 |