| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
19,454 |
9,826 |
$167K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
12,178 |
5,898 |
$118K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
4,377 |
2,148 |
$38K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,443 |
914 |
$34K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
2,268 |
1,128 |
$19K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
1,265 |
676 |
$12K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
171 |
91 |
$2K |
| V2108 |
Spherocylinder, single vision, plus or minus 4.25d to plus or minus 7.00d sphere, 2.12 to 4.00d cylinder, per lens |
97 |
54 |
$840.00 |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
132 |
55 |
$830.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
12 |
12 |
$336.00 |
| 92015 |
Determination of refractive state |
13 |
13 |
$213.46 |
| V2799 |
Vision item or service, miscellaneous |
601 |
272 |
$60.00 |