| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,734 |
1,641 |
$31K |
| V2020 |
Frames, purchases |
2,221 |
2,110 |
$10K |
| V2025 |
Deluxe frame |
56 |
56 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
983 |
932 |
$4K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
165 |
160 |
$3K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
37 |
37 |
$701.68 |
| V2750 |
Anti-reflective coating, per lens |
58 |
54 |
$548.31 |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
13 |
13 |
$0.00 |
| 92002 |
|
156 |
156 |
$0.00 |