| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
93 |
92 |
$4K |
| V2020 |
Frames, purchases |
185 |
177 |
$3K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
72 |
71 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
49 |
46 |
$1K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
13 |
13 |
$625.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
31 |
31 |
$186.00 |
| 92015 |
Determination of refractive state |
199 |
198 |
$0.00 |