| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,750 |
1,710 |
$38K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
901 |
880 |
$36K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
890 |
866 |
$31K |
| V2020 |
Frames, purchases |
1,963 |
1,921 |
$26K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,372 |
1,343 |
$12K |
| 92310 |
|
13 |
13 |
$820.00 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
12 |
12 |
$472.40 |
| 92015 |
Determination of refractive state |
604 |
603 |
$10.00 |
| V2750 |
Anti-reflective coating, per lens |
128 |
126 |
$0.00 |