| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
645 |
606 |
$38K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
235 |
225 |
$12K |
| 92015 |
Determination of refractive state |
1,223 |
1,177 |
$7K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
261 |
252 |
$6K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
202 |
195 |
$6K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
128 |
122 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
136 |
133 |
$4K |
| V2756 |
Eye glass case |
742 |
705 |
$884.65 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
105 |
105 |
$538.89 |
| V2025 |
Deluxe frame |
115 |
114 |
$0.00 |
| S9999 |
Sales tax |
839 |
763 |
$0.00 |