| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
4,876 |
2,589 |
$81K |
| V2020 |
Frames, purchases |
3,064 |
2,987 |
$34K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
879 |
871 |
$26K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
431 |
431 |
$16K |
| 92250 |
|
769 |
761 |
$7K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
955 |
482 |
$854.80 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
26 |
12 |
$400.12 |