| Code | Description | Claims | Beneficiaries | Total Paid |
| V2020 |
Frames, purchases |
675 |
659 |
$30K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
397 |
390 |
$19K |
| V2760 |
Scratch resistant coating, per lens |
511 |
501 |
$9K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
88 |
86 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
147 |
143 |
$5K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
45 |
45 |
$2K |
| 92015 |
Determination of refractive state |
68 |
67 |
$409.50 |