| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,690 |
880 |
$32K |
| V2020 |
Frames, purchases |
1,088 |
1,078 |
$14K |
| 92002 |
|
321 |
321 |
$13K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
101 |
101 |
$6K |
| 92250 |
|
62 |
62 |
$2K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
24 |
12 |
$171.48 |
| 92015 |
Determination of refractive state |
23 |
23 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
500 |
248 |
$0.00 |
| V2755 |
U-v lens, per lens |
290 |
141 |
$0.00 |