| Code | Description | Claims | Beneficiaries | Total Paid |
| V2020 |
Frames, purchases |
574 |
546 |
$29K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
311 |
302 |
$23K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
438 |
423 |
$19K |
| 92015 |
Determination of refractive state |
568 |
553 |
$6K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
147 |
144 |
$6K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
12 |
12 |
$1K |