| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,220 |
1,193 |
$54K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
415 |
409 |
$25K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
261 |
253 |
$15K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
269 |
268 |
$10K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
99 |
98 |
$9K |
| 92015 |
Determination of refractive state |
1,389 |
1,362 |
$7K |
| V2760 |
Scratch resistant coating, per lens |
226 |
221 |
$5K |
| V2783 |
Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens |
12 |
12 |
$1K |