| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,249 |
1,228 |
$20K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
720 |
696 |
$17K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
149 |
143 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
59 |
58 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
91 |
56 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
53 |
53 |
$1K |
| 92015 |
Determination of refractive state |
309 |
302 |
$0.00 |