| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
2,273 |
2,264 |
$37K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,754 |
1,749 |
$33K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
292 |
290 |
$6K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
129 |
129 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
174 |
172 |
$702.00 |
| 92002 |
|
14 |
14 |
$560.00 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
43 |
43 |
$116.00 |
| 92015 |
Determination of refractive state |
158 |
157 |
$0.00 |
| V2025 |
Deluxe frame |
28 |
28 |
$0.00 |