| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
1,410 |
1,363 |
$58K |
| V2020 |
Frames, purchases |
870 |
870 |
$33K |
| 92004 |
|
645 |
600 |
$27K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
435 |
324 |
$25K |
| 92012 |
|
447 |
390 |
$20K |
| 92015 |
|
1,684 |
1,680 |
$18K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
826 |
826 |
$10K |
| 92340 |
|
278 |
278 |
$6K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
331 |
331 |
$3K |
| V2025 |
Deluxe frame |
111 |
79 |
$1K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
14 |
14 |
$630.00 |
| 92065 |
|
19 |
14 |
$418.45 |