| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
422 |
421 |
$15K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
207 |
207 |
$14K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
146 |
145 |
$13K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
157 |
157 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
51 |
51 |
$1K |
| V2756 |
Eye glass case |
380 |
378 |
$398.52 |