| Code | Description | Claims | Beneficiaries | Total Paid |
| V2020 |
Frames, purchases |
3,181 |
3,174 |
$97K |
| 92340 |
|
3,786 |
3,774 |
$78K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
1,637 |
1,635 |
$76K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
1,056 |
1,053 |
$51K |
| 92004 |
|
704 |
693 |
$46K |
| 92341 |
|
1,352 |
1,346 |
$31K |
| 92014 |
|
334 |
331 |
$22K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,965 |
1,516 |
$21K |
| 92015 |
|
1,343 |
1,334 |
$15K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
582 |
434 |
$8K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
760 |
575 |
$8K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
165 |
142 |
$2K |
| 99203 |
|
14 |
13 |
$812.96 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
34 |
25 |
$403.70 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
15 |
12 |
$206.93 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
629 |
330 |
$7.00 |