| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
713 |
712 |
$34K |
| V2020 |
Frames, purchases |
888 |
848 |
$21K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,132 |
1,128 |
$17K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
352 |
339 |
$16K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
564 |
524 |
$13K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
199 |
192 |
$10K |
| 92015 |
Determination of refractive state |
91 |
89 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
619 |
554 |
$1K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
12 |
12 |
$462.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
465 |
461 |
$206.50 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
24 |
24 |
$0.00 |