| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
2,069 |
2,027 |
$58K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
783 |
771 |
$18K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
201 |
197 |
$7K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
85 |
85 |
$6K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
240 |
238 |
$6K |
| V2756 |
Eye glass case |
1,715 |
1,695 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
16 |
16 |
$2K |
| 92002 |
|
13 |
13 |
$633.38 |
| 92015 |
Determination of refractive state |
34 |
34 |
$0.00 |