| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
819 |
689 |
$27K |
| V2020 |
Frames, purchases |
1,589 |
1,323 |
$27K |
| V2025 |
Deluxe frame |
376 |
376 |
$22K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
255 |
212 |
$11K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
92 |
92 |
$5K |
| V2115 |
Lenticular, (myodisc), per lens, single vision |
59 |
44 |
$4K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
26 |
25 |
$1K |
| V2750 |
Anti-reflective coating, per lens |
13 |
13 |
$143.00 |