| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
3,855 |
3,845 |
$55K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,338 |
1,337 |
$46K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,494 |
1,341 |
$30K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,375 |
957 |
$16K |
| 92002 |
|
338 |
337 |
$15K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
453 |
306 |
$7K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,292 |
926 |
$4K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
65 |
65 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
158 |
158 |
$2K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
35 |
35 |
$720.00 |