| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,810 |
903 |
$31K |
| 92002 |
|
595 |
594 |
$20K |
| V2020 |
Frames, purchases |
1,044 |
1,040 |
$12K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
90 |
86 |
$2K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
39 |
39 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
24 |
12 |
$410.80 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
948 |
472 |
$80.00 |
| V2755 |
U-v lens, per lens |
26 |
13 |
$0.00 |
| 92015 |
Determination of refractive state |
81 |
80 |
$0.00 |