| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,790 |
1,291 |
$105K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,611 |
1,169 |
$48K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
311 |
311 |
$14K |
| V2020 |
Frames, purchases |
1,469 |
1,078 |
$10K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
113 |
109 |
$7K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
188 |
188 |
$5K |
| 92015 |
Determination of refractive state |
885 |
879 |
$5K |
| 92002 |
|
67 |
67 |
$2K |