| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
2,725 |
2,716 |
$82K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
880 |
875 |
$33K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
567 |
566 |
$14K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
148 |
148 |
$8K |
| V2115 |
Lenticular, (myodisc), per lens, single vision |
101 |
101 |
$4K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
16 |
16 |
$909.60 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
12 |
12 |
$372.87 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,751 |
1,745 |
$100.41 |
| V2750 |
Anti-reflective coating, per lens |
58 |
56 |
$0.00 |