| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
3,439 |
3,251 |
$83K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,041 |
1,982 |
$46K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
332 |
330 |
$32K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
230 |
217 |
$5K |
| V2756 |
Eye glass case |
3,247 |
3,122 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
16 |
16 |
$1K |
| 92015 |
Determination of refractive state |
69 |
69 |
$0.00 |