| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
832 |
827 |
$45K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
919 |
911 |
$38K |
| 92002 |
|
731 |
715 |
$34K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
160 |
160 |
$9K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
152 |
151 |
$6K |
| V2025 |
Deluxe frame |
19 |
19 |
$876.11 |
| 92015 |
Determination of refractive state |
282 |
276 |
$641.97 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
17 |
16 |
$45.93 |