| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
468 |
437 |
$20K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
100 |
95 |
$6K |
| 92015 |
Determination of refractive state |
402 |
377 |
$2K |
| V2760 |
Scratch resistant coating, per lens |
152 |
139 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
78 |
72 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
14 |
14 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
25 |
25 |
$1K |