| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,007 |
996 |
$17K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
246 |
246 |
$9K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
293 |
290 |
$7K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
43 |
42 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
107 |
105 |
$835.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
20 |
13 |
$264.32 |
| 92015 |
Determination of refractive state |
153 |
152 |
$0.00 |
| V2702 |
Deluxe lens feature |
12 |
12 |
$0.00 |