| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,550 |
1,735 |
$59K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,057 |
1,055 |
$35K |
| V2020 |
Frames, purchases |
2,545 |
2,483 |
$23K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
326 |
326 |
$6K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
144 |
72 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,351 |
1,146 |
$140.00 |