| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,522 |
1,516 |
$47K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
173 |
173 |
$7K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
147 |
93 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
113 |
70 |
$3K |
| 92002 |
|
36 |
35 |
$1K |
| V2101 |
Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens |
12 |
12 |
$600.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
316 |
162 |
$180.00 |
| 92370 |
|
29 |
29 |
$172.99 |
| V2745 |
Addition to lens; tint, any color, solid, gradient or equal, excludes photochromatic, any lens material, per lens |
24 |
12 |
$0.00 |