| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
7,401 |
3,733 |
$133K |
| 92004 |
|
3,482 |
3,475 |
$131K |
| V2020 |
Frames, purchases |
5,205 |
5,140 |
$51K |
| 92015 |
|
2,359 |
2,351 |
$24K |
| 92002 |
|
615 |
613 |
$18K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
682 |
336 |
$17K |
| 92340 |
|
616 |
613 |
$9K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
568 |
283 |
$7K |
| 92012 |
|
260 |
259 |
$6K |
| 92014 |
|
192 |
192 |
$6K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
32 |
32 |
$880.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
4,871 |
2,427 |
$469.00 |
| 3072F |
|
38 |
38 |
$0.00 |
| 92250 |
|
15 |
15 |
$0.00 |