| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,239 |
1,111 |
$41K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,197 |
1,191 |
$40K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
718 |
697 |
$19K |
| V2020 |
Frames, purchases |
1,571 |
1,560 |
$16K |
| 92201 |
|
172 |
167 |
$454.44 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
70 |
35 |
$246.48 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,100 |
544 |
$10.00 |
| 92015 |
Determination of refractive state |
1,484 |
1,475 |
$0.00 |
| V2755 |
U-v lens, per lens |
188 |
94 |
$0.00 |