| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,774 |
2,156 |
$65K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,901 |
1,894 |
$63K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,035 |
1,031 |
$42K |
| V2020 |
Frames, purchases |
2,574 |
2,565 |
$34K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
172 |
86 |
$821.60 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
198 |
100 |
$6.00 |
| 92015 |
Determination of refractive state |
14 |
14 |
$0.00 |
| V2755 |
U-v lens, per lens |
106 |
53 |
$0.00 |