| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
3,054 |
2,957 |
$100K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
675 |
629 |
$62K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
1,297 |
1,225 |
$59K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,394 |
793 |
$33K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,189 |
716 |
$28K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
311 |
311 |
$25K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,271 |
1,102 |
$21K |
| 92015 |
Determination of refractive state |
3,642 |
3,308 |
$16K |
| 92002 |
|
140 |
140 |
$7K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
63 |
39 |
$2K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
15 |
14 |
$437.05 |