| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,983 |
2,928 |
$91K |
| V2025 |
Deluxe frame |
1,914 |
1,885 |
$84K |
| V2020 |
Frames, purchases |
1,417 |
1,388 |
$28K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,288 |
2,240 |
$11K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
188 |
188 |
$8K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
13 |
13 |
$910.00 |
| V2750 |
Anti-reflective coating, per lens |
162 |
162 |
$595.41 |
| V2799 |
Vision item or service, miscellaneous |
263 |
259 |
$155.71 |
| V2744 |
Tint, photochromatic, per lens |
26 |
26 |
$49.26 |
| V2745 |
Addition to lens; tint, any color, solid, gradient or equal, excludes photochromatic, any lens material, per lens |
12 |
12 |
$17.04 |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
30 |
30 |
$11.66 |