| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
2,103 |
2,073 |
$35K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,170 |
1,159 |
$32K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,184 |
1,166 |
$28K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
371 |
369 |
$7K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
39 |
39 |
$1K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
52 |
52 |
$1K |
| 92002 |
|
44 |
41 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
54 |
53 |
$256.00 |