| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
886 |
386 |
$1K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
949 |
410 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
563 |
241 |
$515.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
203 |
90 |
$331.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
430 |
194 |
$117.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
45 |
21 |
$25.00 |