| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92002 |
|
831 |
807 |
$31K |
| V2025 |
Deluxe frame |
106 |
99 |
$7K |
| V2501 |
Contact lens, pmma, toric or prism ballast, per lens |
40 |
40 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
187 |
185 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
107 |
103 |
$4K |
| V2020 |
Frames, purchases |
152 |
152 |
$3K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
46 |
46 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
174 |
172 |
$1K |
| 92015 |
Determination of refractive state |
1,286 |
1,226 |
$0.00 |