| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
4,119 |
4,004 |
$88K |
| 92014 |
|
2,163 |
1,943 |
$77K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,015 |
2,926 |
$60K |
| 92004 |
|
1,219 |
1,100 |
$51K |
| 92015 |
|
2,857 |
2,737 |
$16K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
250 |
250 |
$11K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,442 |
2,366 |
$11K |
| V2299 |
Specialty bifocal (by report) |
97 |
92 |
$3K |
| 92340 |
|
456 |
434 |
$3K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
49 |
49 |
$2K |
| V2781 |
Progressive lens, per lens |
85 |
83 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
67 |
66 |
$2K |
| V2750 |
Anti-reflective coating, per lens |
1,059 |
1,039 |
$21.00 |
| V2744 |
Tint, photochromatic, per lens |
148 |
146 |
$0.00 |