| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
2,154 |
1,920 |
$43K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,526 |
1,354 |
$24K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
105 |
102 |
$13K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
111 |
109 |
$11K |
| V2750 |
Anti-reflective coating, per lens |
642 |
589 |
$3K |
| 92015 |
Determination of refractive state |
401 |
396 |
$2K |
| V2025 |
Deluxe frame |
74 |
47 |
$2K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
44 |
34 |
$595.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
34 |
31 |
$572.00 |