| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,463 |
1,764 |
$56K |
| 92002 |
|
1,244 |
1,243 |
$38K |
| V2020 |
Frames, purchases |
3,119 |
3,049 |
$33K |
| 92285 |
|
911 |
911 |
$27K |
| 92250 |
|
512 |
512 |
$23K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
670 |
668 |
$20K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
357 |
173 |
$9K |
| 92132 |
|
87 |
87 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
176 |
88 |
$903.76 |
| 92133 |
|
12 |
12 |
$360.24 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
3,272 |
1,600 |
$234.00 |
| 92025 |
|
13 |
13 |
$0.00 |