| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,921 |
875 |
$79K |
| V2020 |
Frames, purchases |
2,312 |
1,411 |
$67K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,208 |
1,192 |
$49K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
620 |
605 |
$25K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
379 |
121 |
$10K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
3,996 |
1,174 |
$3K |
| V2760 |
Scratch resistant coating, per lens |
128 |
41 |
$1K |
| 92015 |
Determination of refractive state |
395 |
394 |
$92.70 |