| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,820 |
1,276 |
$93K |
| V2020 |
Frames, purchases |
1,874 |
1,521 |
$58K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
788 |
768 |
$32K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
649 |
645 |
$26K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,514 |
523 |
$3K |
| V2750 |
Anti-reflective coating, per lens |
86 |
41 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
42 |
13 |
$1K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
12 |
12 |
$480.00 |