| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92002 |
|
1,220 |
1,218 |
$58K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,083 |
1,280 |
$48K |
| V2020 |
Frames, purchases |
1,612 |
1,600 |
$28K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
82 |
82 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
66 |
66 |
$3K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
30 |
30 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,879 |
952 |
$1K |
| 92015 |
Determination of refractive state |
64 |
64 |
$1K |
| 92230 |
|
13 |
13 |
$750.82 |