| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,570 |
1,568 |
$64K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
912 |
895 |
$49K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,015 |
1,015 |
$49K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
649 |
649 |
$33K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
359 |
357 |
$5K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
25 |
25 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
68 |
68 |
$4K |
| V2760 |
Scratch resistant coating, per lens |
157 |
155 |
$1K |
| V2750 |
Anti-reflective coating, per lens |
12 |
12 |
$1K |
| 92015 |
Determination of refractive state |
162 |
162 |
$50.00 |