| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
1,219 |
1,219 |
$59K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
479 |
469 |
$22K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,422 |
1,403 |
$21K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
336 |
329 |
$16K |
| V2020 |
Frames, purchases |
451 |
431 |
$12K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
528 |
475 |
$8K |
| 92015 |
Determination of refractive state |
595 |
578 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
796 |
731 |
$900.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
633 |
606 |
$391.50 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$0.00 |