| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,024 |
553 |
$34K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,083 |
580 |
$31K |
| V2020 |
Frames, purchases |
1,167 |
873 |
$24K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
286 |
281 |
$13K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
59 |
59 |
$3K |
| 92015 |
Determination of refractive state |
144 |
143 |
$748.35 |