| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
367 |
367 |
$10K |
| 92002 |
|
322 |
322 |
$9K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
158 |
158 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
224 |
224 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
55 |
55 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
29 |
29 |
$297.13 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$292.87 |