| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
632 |
627 |
$7K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
252 |
140 |
$4K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
69 |
69 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
53 |
53 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
255 |
147 |
$364.00 |
| 92015 |
Determination of refractive state |
15 |
15 |
$19.00 |
| V2755 |
U-v lens, per lens |
54 |
27 |
$0.00 |