| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,962 |
1,447 |
$61K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,237 |
1,237 |
$50K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
1,304 |
633 |
$36K |
| V2020 |
Frames, purchases |
2,933 |
2,870 |
$34K |
| 92002 |
|
251 |
251 |
$10K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
58 |
29 |
$1K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
13 |
13 |
$520.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,534 |
745 |
$270.00 |