| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,440 |
717 |
$30K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
474 |
474 |
$19K |
| V2020 |
Frames, purchases |
652 |
648 |
$7K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
145 |
145 |
$6K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,480 |
736 |
$370.00 |
| 92015 |
Determination of refractive state |
228 |
228 |
$0.00 |