| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,181 |
640 |
$47K |
| V2020 |
Frames, purchases |
2,027 |
1,344 |
$41K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
745 |
546 |
$30K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
887 |
663 |
$460.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
95 |
95 |
$354.00 |
| V2025 |
Deluxe frame |
134 |
107 |
$0.00 |
| V2756 |
Eye glass case |
367 |
248 |
$0.00 |
| 92342 |
|
367 |
248 |
$0.00 |