| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,091 |
1,069 |
$23K |
| V2020 |
Frames, purchases |
1,294 |
1,270 |
$22K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
503 |
490 |
$19K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
205 |
205 |
$8K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
498 |
481 |
$5K |
| 92015 |
Determination of refractive state |
39 |
35 |
$354.11 |