| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,538 |
1,531 |
$38K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
770 |
769 |
$33K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
599 |
599 |
$26K |
| V2020 |
Frames, purchases |
1,598 |
1,593 |
$25K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,278 |
1,273 |
$12K |
| 92015 |
Determination of refractive state |
870 |
869 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
86 |
86 |
$0.00 |