| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,059 |
1,051 |
$75K |
| V2020 |
Frames, purchases |
1,530 |
1,516 |
$66K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
274 |
273 |
$31K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
295 |
295 |
$29K |
| 92015 |
Determination of refractive state |
536 |
536 |
$8K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
64 |
64 |
$1K |