| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,087 |
968 |
$84K |
| V2020 |
Frames, purchases |
1,767 |
1,109 |
$55K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,247 |
1,223 |
$51K |
| V2760 |
Scratch resistant coating, per lens |
543 |
184 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
3,072 |
909 |
$4K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
69 |
69 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
66 |
18 |
$2K |
| 92250 |
|
12 |
12 |
$638.04 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
13 |
13 |
$130.00 |