| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
6,426 |
6,403 |
$135K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
680 |
679 |
$53K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
537 |
537 |
$31K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,622 |
2,621 |
$23K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,716 |
2,703 |
$18K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
504 |
498 |
$3K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
117 |
117 |
$3K |
| V2781 |
Progressive lens, per lens |
86 |
86 |
$817.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
50 |
50 |
$682.00 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
26 |
26 |
$232.50 |