| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,751 |
1,452 |
$48K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
697 |
694 |
$44K |
| 92250 |
|
599 |
598 |
$27K |
| V2020 |
Frames, purchases |
1,631 |
1,623 |
$20K |
| 92002 |
|
414 |
409 |
$11K |
| 92285 |
|
259 |
259 |
$7K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
121 |
121 |
$7K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
64 |
63 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
84 |
42 |
$821.60 |
| 92015 |
Determination of refractive state |
423 |
423 |
$708.70 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,255 |
632 |
$436.00 |
| V2755 |
U-v lens, per lens |
238 |
119 |
$0.00 |