| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
|
819 |
746 |
$19K |
| V2020 |
Frames, purchases |
1,091 |
1,045 |
$15K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
802 |
771 |
$12K |
| 92014 |
|
169 |
158 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
574 |
547 |
$2K |
| 92015 |
|
859 |
826 |
$1K |
| V2299 |
Specialty bifocal (by report) |
40 |
39 |
$962.50 |
| V2781 |
Progressive lens, per lens |
40 |
39 |
$880.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
12 |
12 |
$540.00 |
| V2750 |
Anti-reflective coating, per lens |
28 |
28 |
$0.00 |