| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
3,665 |
3,646 |
$126K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,070 |
1,635 |
$82K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
460 |
367 |
$18K |
| 92341 |
|
823 |
823 |
$16K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,986 |
1,170 |
$15K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
137 |
106 |
$8K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
398 |
398 |
$6K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
262 |
262 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
12 |
12 |
$480.00 |