| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,395 |
1,394 |
$28K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,146 |
1,145 |
$25K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
953 |
952 |
$12K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
962 |
961 |
$12K |
| 92002 |
|
298 |
298 |
$7K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
105 |
105 |
$2K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
108 |
108 |
$1K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
93 |
93 |
$997.78 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
111 |
111 |
$846.45 |