| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92002 |
|
1,072 |
1,070 |
$33K |
| V2020 |
Frames, purchases |
1,071 |
1,068 |
$16K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
367 |
367 |
$15K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
704 |
351 |
$13K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
689 |
349 |
$12K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
12 |
12 |
$485.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
620 |
311 |
$12.00 |
| V2755 |
U-v lens, per lens |
76 |
38 |
$0.00 |