| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
2,252 |
1,669 |
$290K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,952 |
1,872 |
$186K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,312 |
1,261 |
$147K |
| V2020 |
Frames, purchases |
1,773 |
1,446 |
$59K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,509 |
1,852 |
$55K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,059 |
799 |
$55K |
| V2025 |
Deluxe frame |
685 |
413 |
$51K |
| 92250 |
|
1,134 |
1,087 |
$51K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
2,072 |
1,585 |
$36K |
| V2750 |
Anti-reflective coating, per lens |
1,199 |
703 |
$32K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
722 |
551 |
$30K |
| V2755 |
U-v lens, per lens |
690 |
405 |
$20K |
| V2781 |
Progressive lens, per lens |
34 |
25 |
$3K |
| V2430 |
Variable asphericity lens, bifocal, full field, glass or plastic, per lens |
21 |
14 |
$3K |
| 92341 |
|
21 |
12 |
$412.30 |
| 92342 |
|
21 |
13 |
$393.76 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
22 |
16 |
$123.08 |
| 92015 |
Determination of refractive state |
13 |
13 |
$0.00 |