| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
834 |
828 |
$49K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
883 |
878 |
$43K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
361 |
358 |
$16K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
284 |
284 |
$12K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
94 |
94 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
124 |
124 |
$1K |
| V2025 |
Deluxe frame |
15 |
15 |
$493.69 |
| 92015 |
Determination of refractive state |
532 |
525 |
$16.44 |