| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
544 |
543 |
$34K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,135 |
1,057 |
$31K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
24 |
12 |
$635.48 |
| V2020 |
Frames, purchases |
64 |
64 |
$588.50 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
146 |
73 |
$575.12 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
14 |
14 |
$212.10 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,762 |
1,369 |
$30.00 |
| V2755 |
U-v lens, per lens |
24 |
12 |
$0.00 |