| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,696 |
1,654 |
$31K |
| 92002 |
|
615 |
610 |
$18K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
548 |
528 |
$12K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
504 |
499 |
$12K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
115 |
113 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
56 |
56 |
$2K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
16 |
16 |
$553.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
33 |
31 |
$378.00 |