| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
8,042 |
4,083 |
$140K |
| 92002 |
|
3,433 |
3,430 |
$117K |
| V2020 |
Frames, purchases |
4,793 |
4,780 |
$44K |
| 92012 |
|
453 |
453 |
$17K |
| 92004 |
|
734 |
733 |
$9K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
4,546 |
2,265 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
290 |
145 |
$2K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
30 |
30 |
$560.00 |
| 92015 |
|
163 |
163 |
$400.00 |
| V2755 |
U-v lens, per lens |
446 |
223 |
$0.00 |