| Code | Description | Claims | Beneficiaries | Total Paid |
| 92015 |
Determination of refractive state |
403 |
383 |
$10K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
221 |
211 |
$8K |
| V2020 |
Frames, purchases |
211 |
203 |
$3K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
116 |
113 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
39 |
37 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
26 |
26 |
$1K |