| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
6,693 |
3,343 |
$118K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,229 |
2,227 |
$87K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,318 |
2,318 |
$82K |
| V2020 |
Frames, purchases |
4,395 |
4,378 |
$47K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
538 |
270 |
$6K |
| 92015 |
Determination of refractive state |
178 |
178 |
$6K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
151 |
151 |
$2K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
55 |
55 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,589 |
1,291 |
$376.56 |
| V2755 |
U-v lens, per lens |
84 |
41 |
$0.00 |