| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,529 |
860 |
$58K |
| V2020 |
Frames, purchases |
1,144 |
1,033 |
$39K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
755 |
735 |
$31K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
316 |
310 |
$13K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
237 |
236 |
$9K |
| V2025 |
Deluxe frame |
155 |
150 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
398 |
168 |
$1K |
| V2523 |
Contact lens, hydrophilic, extended wear, per lens |
12 |
12 |
$986.00 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
17 |
13 |
$981.33 |
| 92015 |
Determination of refractive state |
258 |
245 |
$60.00 |