| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
540 |
454 |
$6K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
311 |
239 |
$4K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
74 |
74 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
64 |
64 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
193 |
145 |
$2K |
| 92002 |
|
14 |
14 |
$601.44 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
31 |
25 |
$550.00 |