| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,939 |
1,938 |
$80K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,327 |
1,311 |
$71K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,472 |
1,466 |
$70K |
| V2020 |
Frames, purchases |
3,824 |
3,773 |
$43K |
| V2199 |
Not otherwise classified, single vision lens |
1,330 |
663 |
$25K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
231 |
222 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
4,637 |
2,298 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
86 |
43 |
$2K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
48 |
24 |
$1K |
| V2750 |
Anti-reflective coating, per lens |
56 |
28 |
$0.00 |