| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
2,100 |
2,044 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,736 |
1,439 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
41 |
41 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
25 |
25 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,176 |
611 |
$1K |
| 92015 |
Determination of refractive state |
189 |
188 |
$743.60 |
| V2520 |
Contact lens, hydrophilic, spherical, per lens |
54 |
54 |
$100.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
318 |
157 |
$0.00 |