| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
2,263 |
2,228 |
$29K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,226 |
1,210 |
$22K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,917 |
1,894 |
$17K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
394 |
379 |
$8K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
188 |
184 |
$4K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
213 |
213 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
115 |
112 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
16 |
14 |
$220.00 |
| V2750 |
Anti-reflective coating, per lens |
31 |
30 |
$0.00 |