| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,882 |
1,865 |
$101K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,485 |
1,478 |
$95K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
756 |
753 |
$52K |
| V2201 |
Sphere, bifocal, plus or minus 4.12 to plus or minus 7.00d, per lens |
394 |
391 |
$39K |
| V2755 |
U-v lens, per lens |
1,906 |
1,889 |
$35K |
| V2760 |
Scratch resistant coating, per lens |
1,917 |
1,901 |
$26K |
| V2745 |
Addition to lens; tint, any color, solid, gradient or equal, excludes photochromatic, any lens material, per lens |
1,368 |
1,352 |
$11K |
| V2101 |
Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens |
16 |
16 |
$637.50 |