| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
3,044 |
3,028 |
$151K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,132 |
2,122 |
$100K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,119 |
2,105 |
$66K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
874 |
871 |
$43K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
841 |
839 |
$20K |
| 92015 |
Determination of refractive state |
1,252 |
1,248 |
$20K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
168 |
168 |
$9K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
330 |
330 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
76 |
76 |
$2K |
| 92341 |
|
21 |
21 |
$780.20 |
| V2745 |
Addition to lens; tint, any color, solid, gradient or equal, excludes photochromatic, any lens material, per lens |
16 |
16 |
$303.00 |