| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
5,676 |
3,288 |
$114K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,923 |
2,891 |
$110K |
| V2020 |
Frames, purchases |
6,070 |
5,938 |
$80K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,512 |
780 |
$30K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
945 |
531 |
$27K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
8,258 |
4,376 |
$8K |
| 92341 |
|
232 |
230 |
$4K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
103 |
103 |
$2K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
44 |
24 |
$1K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
28 |
28 |
$1K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
47 |
25 |
$995.68 |
| 92002 |
|
23 |
23 |
$890.00 |
| 92015 |
Determination of refractive state |
1,344 |
1,334 |
$555.00 |
| 92250 |
|
262 |
260 |
$245.00 |