| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
839 |
832 |
$29K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
144 |
143 |
$11K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
53 |
32 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
12 |
12 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
31 |
19 |
$925.78 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
52 |
25 |
$130.00 |