| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,725 |
1,407 |
$35K |
| V2020 |
Frames, purchases |
2,200 |
2,173 |
$30K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
336 |
332 |
$10K |
| 92002 |
|
178 |
177 |
$7K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,214 |
821 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
379 |
191 |
$3K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
28 |
14 |
$342.96 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
15 |
15 |
$240.00 |