| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,358 |
1,201 |
$28K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,361 |
1,193 |
$21K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
964 |
830 |
$17K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
175 |
172 |
$17K |
| 92015 |
Determination of refractive state |
755 |
738 |
$8K |
| 92250 |
|
231 |
226 |
$6K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
225 |
180 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
57 |
54 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
43 |
40 |
$3K |
| V2025 |
Deluxe frame |
53 |
52 |
$0.00 |