| Code | Description | Claims | Beneficiaries | Total Paid |
| V2020 |
Frames, purchases |
870 |
856 |
$27K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
828 |
813 |
$16K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
78 |
78 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
214 |
212 |
$2K |
| 92015 |
Determination of refractive state |
179 |
179 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
23 |
23 |
$2K |
| V2101 |
Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens |
96 |
96 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
79 |
77 |
$964.18 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
13 |
13 |
$610.35 |
| V2756 |
Eye glass case |
654 |
644 |
$74.25 |