| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
286 |
280 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
157 |
156 |
$3K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
91 |
90 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
57 |
57 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
63 |
62 |
$550.00 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
12 |
12 |
$405.00 |