| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
420 |
402 |
$20K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
376 |
366 |
$17K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
208 |
191 |
$9K |
| V2020 |
Frames, purchases |
366 |
349 |
$8K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
95 |
95 |
$4K |
| 92015 |
Determination of refractive state |
293 |
292 |
$3K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
108 |
91 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
73 |
73 |
$938.78 |