| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,418 |
970 |
$1K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
1,172 |
804 |
$539.13 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
33 |
12 |
$168.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
821 |
630 |
$124.40 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
277 |
107 |
$120.00 |
| 92002 |
|
354 |
256 |
$100.00 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
70 |
60 |
$0.00 |