| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
993 |
953 |
$76K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
738 |
725 |
$57K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
620 |
595 |
$29K |
| 92015 |
Determination of refractive state |
1,850 |
1,808 |
$21K |
| V2025 |
Deluxe frame |
12 |
12 |
$1K |
| V2781 |
Progressive lens, per lens |
12 |
12 |
$896.50 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
13 |
13 |
$308.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
12 |
12 |
$148.50 |