| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
4,307 |
4,119 |
$120K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,990 |
2,864 |
$96K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
3,582 |
3,436 |
$70K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
2,482 |
2,373 |
$68K |
| 92370 |
|
583 |
564 |
$4K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
39 |
38 |
$2K |
| 92341 |
|
32 |
30 |
$701.80 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
16 |
16 |
$350.02 |