| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
914 |
825 |
$54K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
791 |
720 |
$23K |
| V2020 |
Frames, purchases |
635 |
560 |
$10K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
119 |
119 |
$5K |
| 92015 |
Determination of refractive state |
57 |
56 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
52 |
50 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
29 |
24 |
$1K |
| V2520 |
Contact lens, hydrophilic, spherical, per lens |
13 |
13 |
$919.30 |
| V2750 |
Anti-reflective coating, per lens |
17 |
15 |
$61.00 |