| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
4,831 |
4,750 |
$190K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,551 |
1,545 |
$148K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
917 |
915 |
$106K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,902 |
2,223 |
$54K |
| 92015 |
Determination of refractive state |
419 |
418 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
85 |
66 |
$1K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
74 |
70 |
$785.73 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,354 |
677 |
$92.20 |