| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,035 |
1,035 |
$62K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
398 |
375 |
$22K |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
120 |
114 |
$14K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
364 |
358 |
$9K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
73 |
73 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
12 |
12 |
$528.25 |