| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
2,277 |
1,657 |
$17K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,713 |
1,186 |
$7K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
519 |
493 |
$6K |
| S0504 |
Single vision prescription lens (safety, athletic, or sunglass), per lens |
229 |
222 |
$5K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
302 |
212 |
$1K |
| V2781 |
Progressive lens, per lens |
24 |
24 |
$1K |
| S0500 |
Disposable contact lens, per lens |
12 |
12 |
$956.80 |
| V2300 |
Sphere, trifocal, plano to plus or minus 4.00d, per lens |
12 |
12 |
$490.00 |
| S0506 |
Bifocal vision prescription lens (safety, athletic, or sunglass), per lens |
15 |
15 |
$451.00 |
| 92004 |
|
13 |
12 |
$180.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,318 |
826 |
$0.00 |
| V2520 |
Contact lens, hydrophilic, spherical, per lens |
64 |
34 |
$0.00 |