| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
4,100 |
3,944 |
$62K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,923 |
1,850 |
$46K |
| V2781 |
Progressive lens, per lens |
27 |
27 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
120 |
117 |
$2K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
24 |
24 |
$1K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
24 |
24 |
$478.50 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
14 |
12 |
$246.50 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
94 |
86 |
$132.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
160 |
152 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
249 |
237 |
$0.00 |