| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
|
699 |
699 |
$52K |
| V2020 |
Frames, purchases |
1,527 |
1,517 |
$41K |
| 92014 |
|
392 |
392 |
$23K |
| 92015 |
|
1,316 |
1,316 |
$13K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
779 |
776 |
$8K |
| 92340 |
|
279 |
279 |
$6K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
455 |
455 |
$5K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
71 |
71 |
$3K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
66 |
66 |
$729.95 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
14 |
14 |
$196.33 |
| V2750 |
Anti-reflective coating, per lens |
99 |
99 |
$0.00 |