| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,457 |
970 |
$46K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
920 |
411 |
$25K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
270 |
263 |
$11K |
| V2750 |
Anti-reflective coating, per lens |
100 |
27 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
56 |
27 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
29 |
29 |
$1K |
| 92002 |
|
12 |
12 |
$505.40 |
| 92015 |
Determination of refractive state |
100 |
100 |
$35.00 |