| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,860 |
1,840 |
$58K |
| 92002 |
|
1,269 |
1,245 |
$50K |
| V2025 |
Deluxe frame |
1,270 |
1,256 |
$45K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
808 |
787 |
$31K |
| V2020 |
Frames, purchases |
646 |
639 |
$13K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
950 |
935 |
$4K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
41 |
41 |
$3K |
| V2781 |
Progressive lens, per lens |
13 |
13 |
$617.35 |
| V2760 |
Scratch resistant coating, per lens |
346 |
338 |
$327.74 |
| 92015 |
Determination of refractive state |
2,479 |
2,426 |
$284.00 |