| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
5,910 |
3,872 |
$296K |
| V2020 |
Frames, purchases |
5,376 |
4,815 |
$116K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
2,279 |
2,208 |
$84K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,175 |
2,112 |
$83K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
1,182 |
922 |
$74K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,148 |
1,127 |
$55K |
| 92250 |
|
998 |
952 |
$41K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
212 |
188 |
$7K |
| V2025 |
Deluxe frame |
517 |
514 |
$6K |
| 92015 |
Determination of refractive state |
898 |
882 |
$6K |
| 92083 |
|
84 |
78 |
$5K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
444 |
442 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,811 |
638 |
$4K |
| V2760 |
Scratch resistant coating, per lens |
210 |
144 |
$1K |
| V2744 |
Tint, photochromatic, per lens |
59 |
41 |
$1K |
| 92341 |
|
25 |
25 |
$300.00 |
| 92020 |
|
17 |
16 |
$217.60 |
| 1036F |
|
602 |
575 |
$0.00 |