| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
192 |
96 |
$3K |
| V2020 |
Frames, purchases |
235 |
234 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
27 |
27 |
$840.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
38 |
38 |
$560.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
40 |
20 |
$0.00 |
| V2755 |
U-v lens, per lens |
24 |
12 |
$0.00 |
| 92015 |
Determination of refractive state |
15 |
15 |
$0.00 |