| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
732 |
730 |
$18K |
| V2020 |
Frames, purchases |
882 |
879 |
$17K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
287 |
287 |
$12K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
237 |
237 |
$10K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
486 |
484 |
$5K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
38 |
38 |
$1K |
| 92015 |
Determination of refractive state |
681 |
681 |
$41.66 |
| V2760 |
Scratch resistant coating, per lens |
46 |
46 |
$0.00 |