| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
9,263 |
5,008 |
$160K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,665 |
2,632 |
$102K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,083 |
2,067 |
$74K |
| V2020 |
Frames, purchases |
6,136 |
6,103 |
$71K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,742 |
869 |
$18K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
784 |
784 |
$12K |
| 92015 |
Determination of refractive state |
500 |
499 |
$7K |
| V2219 |
Bifocal seg width over 28 mm |
69 |
68 |
$6K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
107 |
54 |
$2K |
| V2207 |
Spherocylinder, bifocal, plus or minus 4.25 to plus or minus 7.00d sphere,.12 to 2.00d cylinder, per lens |
69 |
68 |
$2K |
| 92250 |
|
33 |
33 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
5,437 |
2,787 |
$2K |
| 92341 |
|
68 |
68 |
$1K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
24 |
12 |
$171.48 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
24 |
12 |
$123.24 |
| V2755 |
U-v lens, per lens |
1,348 |
674 |
$0.00 |