| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
666 |
665 |
$13K |
| V2020 |
Frames, purchases |
894 |
893 |
$12K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
506 |
498 |
$12K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
333 |
330 |
$8K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
530 |
530 |
$3K |
| V2781 |
Progressive lens, per lens |
74 |
74 |
$2K |
| V2299 |
Specialty bifocal (by report) |
74 |
74 |
$2K |
| V2750 |
Anti-reflective coating, per lens |
77 |
77 |
$0.00 |
| 92015 |
Determination of refractive state |
197 |
197 |
$0.00 |