| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
837 |
803 |
$10K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
216 |
210 |
$7K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
453 |
427 |
$6K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
373 |
353 |
$4K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
104 |
102 |
$3K |
| 92002 |
|
16 |
16 |
$687.36 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
14 |
12 |
$0.00 |