| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,328 |
1,315 |
$39K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
545 |
542 |
$37K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
270 |
265 |
$6K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
71 |
71 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
119 |
117 |
$3K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
15 |
15 |
$1K |
| V2756 |
Eye glass case |
1,234 |
1,226 |
$1K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
27 |
27 |
$997.38 |