| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,951 |
1,949 |
$140K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,387 |
2,375 |
$110K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,113 |
1,113 |
$63K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
608 |
608 |
$31K |
| V2025 |
Deluxe frame |
120 |
120 |
$7K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
59 |
59 |
$1K |
| 92015 |
Determination of refractive state |
105 |
105 |
$10.00 |