| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
3,079 |
3,028 |
$98K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,513 |
1,490 |
$67K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,967 |
1,930 |
$63K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,129 |
1,114 |
$51K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,006 |
997 |
$18K |
| 92015 |
Determination of refractive state |
595 |
587 |
$12K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
378 |
377 |
$6K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
647 |
644 |
$3K |
| 92060 |
|
42 |
42 |
$3K |
| V2025 |
Deluxe frame |
27 |
27 |
$1K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
12 |
12 |
$635.25 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
12 |
12 |
$177.50 |