| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,039 |
1,572 |
$48K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,730 |
1,725 |
$38K |
| V2020 |
Frames, purchases |
2,612 |
2,581 |
$27K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
301 |
300 |
$9K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
134 |
67 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
266 |
132 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,525 |
1,264 |
$384.00 |
| 92015 |
Determination of refractive state |
1,777 |
1,756 |
$136.80 |
| V2755 |
U-v lens, per lens |
156 |
78 |
$0.00 |