| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
3,016 |
2,999 |
$92K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,786 |
2,159 |
$76K |
| 92250 |
|
1,701 |
1,697 |
$75K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,379 |
1,366 |
$61K |
| 92002 |
|
1,466 |
1,460 |
$58K |
| 92285 |
|
1,270 |
1,264 |
$36K |
| 92083 |
|
630 |
626 |
$29K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
1,184 |
648 |
$27K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
325 |
318 |
$18K |
| 92133 |
|
196 |
196 |
$6K |
| 76514 |
|
691 |
689 |
$5K |
| 76512 |
|
34 |
28 |
$2K |
| 92020 |
|
172 |
172 |
$2K |
| 92081 |
|
57 |
57 |
$2K |
| 92132 |
|
64 |
64 |
$2K |
| 92015 |
Determination of refractive state |
12 |
12 |
$38.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
212 |
105 |
$0.00 |