| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
417 |
415 |
$10K |
| V2020 |
Frames, purchases |
463 |
461 |
$9K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
187 |
187 |
$6K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
169 |
168 |
$1K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
28 |
28 |
$810.00 |
| 92015 |
Determination of refractive state |
509 |
508 |
$0.00 |