| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,320 |
1,125 |
$90K |
| V2020 |
Frames, purchases |
2,430 |
1,707 |
$78K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,427 |
1,402 |
$62K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,056 |
1,039 |
$44K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,632 |
839 |
$11K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
56 |
18 |
$1K |
| 92015 |
Determination of refractive state |
220 |
214 |
$886.50 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
14 |
13 |
$140.00 |