| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
11,339 |
6,076 |
$203K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
4,531 |
4,525 |
$137K |
| V2020 |
Frames, purchases |
8,182 |
8,154 |
$86K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,607 |
1,604 |
$53K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,266 |
1,135 |
$21K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
9,826 |
5,063 |
$5K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
122 |
60 |
$1K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
26 |
13 |
$123.24 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
14 |
14 |
$0.00 |
| 92015 |
Determination of refractive state |
145 |
145 |
$0.00 |
| V2755 |
U-v lens, per lens |
396 |
198 |
$0.00 |