| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,779 |
1,778 |
$105K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,272 |
1,272 |
$63K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,137 |
1,137 |
$60K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
932 |
931 |
$52K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
255 |
255 |
$15K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
45 |
45 |
$2K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
24 |
24 |
$892.50 |
| V2025 |
Deluxe frame |
12 |
12 |
$600.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
41 |
41 |
$0.00 |
| 92015 |
Determination of refractive state |
206 |
206 |
$0.00 |