| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,257 |
1,150 |
$51K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
699 |
652 |
$47K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,531 |
1,407 |
$45K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
527 |
481 |
$18K |
| V2020 |
Frames, purchases |
1,326 |
1,214 |
$10K |
| 92015 |
Determination of refractive state |
2,054 |
1,914 |
$5K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,806 |
1,640 |
$5K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
14 |
13 |
$1K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
27 |
26 |
$540.00 |
| 92341 |
|
31 |
26 |
$206.32 |
| V2025 |
Deluxe frame |
702 |
634 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
40 |
38 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
236 |
225 |
$0.00 |