| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,152 |
576 |
$24K |
| V2020 |
Frames, purchases |
1,345 |
1,345 |
$16K |
| 92004 |
|
356 |
353 |
$14K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
659 |
330 |
$14K |
| V2500 |
Contact lens, pmma, spherical, per lens |
12 |
12 |
$7K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
122 |
61 |
$3K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
15 |
15 |
$600.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,640 |
1,320 |
$0.00 |