| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
1,025 |
1,025 |
$50K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
850 |
819 |
$40K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,955 |
1,927 |
$29K |
| V2020 |
Frames, purchases |
1,646 |
1,584 |
$28K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
964 |
862 |
$16K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
164 |
157 |
$14K |
| 92015 |
Determination of refractive state |
413 |
388 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,068 |
969 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
764 |
736 |
$568.50 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
12 |
12 |
$173.25 |
| V2750 |
Anti-reflective coating, per lens |
15 |
15 |
$0.00 |