| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
224 |
220 |
$4K |
| V2020 |
Frames, purchases |
243 |
238 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
109 |
91 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
141 |
141 |
$752.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
43 |
36 |
$590.00 |
| 92015 |
Determination of refractive state |
71 |
60 |
$0.00 |