| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
1,025 |
1,025 |
$51K |
| V2020 |
Frames, purchases |
1,417 |
1,373 |
$29K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,718 |
1,701 |
$26K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
537 |
519 |
$23K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
855 |
781 |
$19K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
299 |
275 |
$14K |
| 92015 |
Determination of refractive state |
210 |
189 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,133 |
1,058 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
766 |
737 |
$320.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
14 |
14 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
39 |
39 |
$0.00 |
| V2744 |
Tint, photochromatic, per lens |
13 |
12 |
$0.00 |