| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
586 |
573 |
$12K |
| V2020 |
Frames, purchases |
430 |
418 |
$8K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
171 |
171 |
$6K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
604 |
592 |
$5K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
27 |
27 |
$810.00 |
| 92015 |
Determination of refractive state |
154 |
153 |
$0.00 |