| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
500 |
480 |
$10K |
| V2020 |
Frames, purchases |
631 |
607 |
$6K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
599 |
576 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
57 |
52 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
16 |
16 |
$300.00 |
| 92015 |
Determination of refractive state |
12 |
12 |
$77.00 |