| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
563 |
555 |
$16K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
237 |
236 |
$15K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
275 |
185 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
55 |
55 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
68 |
39 |
$240.00 |
| 92015 |
Determination of refractive state |
13 |
12 |
$15.20 |