| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92002 |
|
321 |
309 |
$9K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
345 |
318 |
$7K |
| V2020 |
Frames, purchases |
386 |
380 |
$6K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
36 |
24 |
$396.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
42 |
28 |
$176.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
23 |
23 |
$170.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
28 |
14 |
$0.00 |