| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,551 |
1,536 |
$18K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
905 |
506 |
$14K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
213 |
210 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
239 |
124 |
$1K |
| 92002 |
|
12 |
12 |
$480.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,365 |
695 |
$225.50 |
| V2755 |
U-v lens, per lens |
28 |
14 |
$0.00 |
| 92015 |
Determination of refractive state |
19 |
15 |
$0.00 |