| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
3,950 |
3,630 |
$167K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
4,631 |
4,307 |
$155K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,404 |
2,218 |
$138K |
| V2020 |
Frames, purchases |
4,976 |
4,563 |
$42K |
| 92015 |
Determination of refractive state |
6,720 |
6,221 |
$40K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
5,766 |
5,312 |
$37K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,150 |
1,047 |
$35K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
770 |
715 |
$27K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
606 |
545 |
$27K |
| V2599 |
Contact lens, other type |
168 |
151 |
$21K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
195 |
183 |
$7K |
| 92341 |
|
710 |
639 |
$3K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
12 |
12 |
$367.50 |
| 92310 |
|
163 |
151 |
$100.00 |
| V2744 |
Tint, photochromatic, per lens |
18 |
15 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
289 |
277 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
545 |
517 |
$-65.00 |
| V2025 |
Deluxe frame |
2,038 |
1,871 |
$-246.00 |