| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
894 |
765 |
$2K |
| V2020 |
Frames, purchases |
1,100 |
952 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
353 |
255 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,029 |
898 |
$2K |
| V2781 |
Progressive lens, per lens |
43 |
43 |
$330.00 |
| V2299 |
Specialty bifocal (by report) |
43 |
43 |
$226.20 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
13 |
12 |
$150.80 |
| V2750 |
Anti-reflective coating, per lens |
612 |
539 |
$0.00 |
| 92015 |
Determination of refractive state |
50 |
21 |
$0.00 |