| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,835 |
1,819 |
$65K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
245 |
243 |
$6K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
122 |
120 |
$4K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
53 |
52 |
$3K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
26 |
26 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
117 |
115 |
$1K |
| V2101 |
Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens |
26 |
26 |
$1K |
| 92341 |
|
46 |
46 |
$920.00 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
12 |
12 |
$360.00 |
| 92002 |
|
27 |
26 |
$0.00 |