| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
342 |
340 |
$6K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
226 |
226 |
$5K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
95 |
95 |
$4K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
59 |
59 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
29 |
29 |
$350.00 |
| 92015 |
Determination of refractive state |
349 |
349 |
$0.00 |