| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
9,710 |
5,162 |
$176K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,688 |
2,686 |
$94K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,207 |
2,204 |
$79K |
| V2020 |
Frames, purchases |
6,017 |
5,995 |
$70K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
8,081 |
4,182 |
$6K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
396 |
197 |
$5K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
52 |
27 |
$1K |
| V2755 |
U-v lens, per lens |
82 |
41 |
$0.00 |