| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,920 |
1,297 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
12,497 |
6,898 |
$0.00 |
| 92002 |
|
4,163 |
4,139 |
$0.00 |
| S0500 |
Disposable contact lens, per lens |
1,678 |
1,659 |
$0.00 |
| V2744 |
Tint, photochromatic, per lens |
2,061 |
1,018 |
$0.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
625 |
623 |
$0.00 |
| 92250 |
|
1,687 |
1,662 |
$0.00 |
| V2799 |
Vision item or service, miscellaneous |
597 |
299 |
$0.00 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
1,271 |
838 |
$0.00 |
| S0581 |
Nonstandard lens (list this code in addition to the basic code for the lens) |
640 |
319 |
$0.00 |
| 92310 |
|
1,491 |
1,457 |
$0.00 |
| V2781 |
Progressive lens, per lens |
56 |
28 |
$0.00 |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
20 |
12 |
$0.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
7,815 |
7,726 |
$0.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,155 |
1,178 |
$0.00 |
| V2020 |
Frames, purchases |
10,987 |
10,871 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
5,949 |
2,979 |
$0.00 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
614 |
375 |
$0.00 |